Postoperative Perineal Hernia Research Articles

Experience in the treatment of a patient with postoperative perineal hernia after extended combined abdominal-perineal extirpation of the rectum

Experience in the treatment of a patient with postoperative perineal hernia after extended combined abdominal-perineal extirpation of the rectum

Perineal hernia repair following tailgut cyst excision: A case report and literature review of optimal management strategies

Perineal hernias, categorised as primary or secondary, pose a clinical challenge necessitating surgical intervention. Herein we present the surgical management of a postoperative perineal hernia of the retrorectal space. A 42-year-old female patient presented to the clinic with symptoms such as perineal discomfort, bulging, and constipation after previous surgical tailgut cyst excision. Diagnosis involved MRI, confirming rectal herniation into the retrorectal space. The surgical approach featured a perineal intervention using a unilateral inferior gluteal flap to reinforce the posterior rectal space, avoiding mesh complications. The patient experienced a successful recovery, highlighting the importance of tailored interventions based on symptoms and complications. Secondary perineal hernias, often postoperative, present diverse challenges influenced by multiple factors such as pelvic surgeries. Surgical repair options include perineal and abdominal approaches, mesh usage, and flap methods, each with variable outcomes. This case study contributes to the evolving understanding of perineal hernias, emphasising the need for multidisciplinary approaches and ongoing research to enhance management strategies in this complex clinical scenario.

Summary of experience with patterning cropped and shaped mesh repair for perineal hernia after abdominoperineal excision in rectal cancer

Objective: To examine the patterning cropped and shaped mesh repair for perineal hernia after abdominoperineal excision (APE) in rectal cancer. Methods: The clinical data of 8 patients with perineal hernia after APE who accepted surgical treatment in the Department of Hepatopancreatobiliary and Hernia Surgery, the First Affiliated Hospital of Fujian Medical University from March 2017 to December 2022 were retrospectively reviewed. There were 3 males and 5 females, aged (67.6±7.2) years (range: 56 to 76 years). Eight patients developed a perineal mass at (11.3±2.9) months (range: 5 to 13 months) after APE. After surgical separation of adhesion and exposing the pelvic floor defect, a 15 cm×20 cm anti-adhesion mesh was fashioned as a three-dimensional pocket shape to fit the pelvic defect, then fixed to the promontory or sacrum and sutured to the pelvic sidewalls and the anterior peritoneum, while two side slender slings were tailored in front of the mesh and fixed on the pectineal ligament. Results: The repair of their perineal hernias went well, with an operating time of (240.6±48.8) minutes (range: 155 to 300 minutes). Five patients underwent laparotomy, 3 patients tried laparoscopic surgery first and then transferred to laparotomy combined with the perineal approach. Intraoperative bowel injury was observed in 3 patients. All patients did not have an intestinal fistula, bleeding occurred. No reoperation was performed and their preoperative symptoms improved significantly. The postoperative hospital stay was (13.5±2.9) days (range: 7 to 17 days) and two patients had postoperative ileus, which improved after conservative treatment. Two patients had a postoperative perineal hernia sac effusion, one of them underwent placement of a tube to puncture the hernia sac effusion due to infection, and continued irrigation and drainage. The postoperative follow-up was (34.8±14.0) months (range: 13 to 48 months), and 1 patient developed recurrence in the seventh postoperative month, no further surgery was performed. Conclusions: Surgical repair of the perineal hernia after APE can be preferred transabdominal approach, routine application of laparoscopy is not recommended, combined abdominoperineal approach can be considered if necessary. The perineal hernia after APE can be repaired safely and effectively using the described technique of patterning cropped and shaped mesh repair.

Postoperative perineal hernia repair: what is the evidence?

The present study determined the characteristics of perineal hernia treatment in the literature, and the incidence of postoperative recurrence was stratified according to repair techniques. A systematic search of the available literature on the treatment of postoperative perineal hernias was performed using a major database. The types of repair techniques and outcome were entered into an electronic database and a pooled analysis was performed. A total of 213 cases of postoperative perineal hernia repair were collected from 20 relevant articles in the literature after excluding case reports (n < 3). Synthetic mesh was the material used most frequently for perineal hernia repair (55.9%). The most frequently used approach in perineal hernia repair was the perineal approach (56.5%). The recurrence rate was highest with the use of biological mesh (40.4%) and the perineal approach (35.6%). The recurrence rate was lowest in the combined abdominal & perineal approach (0%), followed by the abdominal approach (8.8%) and the laparoscopic approach (11.8%). A number of different repair techniques have been described in the literature. The use of synthetic mesh via a combined abdominal-perineal approach or intraabdominal/laparoscopic approach was shown to be associated with a reduced postoperative recurrence rate.

Perineal Repair of a Postoperative Perineal Hernia – Case Report

Postoperative perineal hernia (PerH) following abdominoperineal resection is a rare complication of radical pelvic oncologic surgery performed with curative intent for rectal cancer, with a reported prevalence of 0.6–7%. PerH is clinically diagnosed as an occurrence of a swelling in the perineum caused by the herniation of abdominal or pelvic viscera through a defect in the pelvic floor. The definitive repair method of pelvic floor defect of PerH is not established but includes exclusion of tumor recurrence and repair of pelvic floor defect. We herein report the treatment of a PerH using a combination of biological mesh and a V-Y gluteal fascio-cutaneous advancement flap, performed at Tata Memorial Hospital, in Parel, Mumbai, India.

Surgical Repair of Postoperative Perineal Hernia: A Case for the Perineal Approach

Perineal hernia is a well-known, rare complication following abdominoperineal resection for rectal cancer. Due to its rarity, the literature on its surgical repair is comprised of case reports and small case series, and not one surgical approach has been established as superior. This study aimed to identify the repair methods used at our institution and their outcomes. We hypothesized that a perineal approach would have a similar recurrence rate to a transabdominal repair with shorter hospital length of stay. This study was a retrospective case series. This study was conducted in a large, single institution setting. Patients who underwent surgical repair for perineal hernia from January 2009 to December 2019 were included. The primary outcomes were perineal hernia recurrence, surgical approach to repair, and length of stay. We identified 36 patients who underwent surgical repair of perineal hernia at our institution. Twenty patients received neoadjuvant chemoradiation therapy. Most patients (29) had previously undergone abdominoperineal resection; 5 were robotic, 15 were laparoscopic, 1 was robotic converted to open, and 8 were open. Patients were repaired through a perineal approach (22) or transabdominally (14). The median length of stay was 4 days (1-12) after a perineal approach and 8 days (3-18) after a transabdominal approach. At a median follow-up of 12.7 months (1-72), there were 4 recurrences after perineal repair and 3 recurrences after transabdominal repair. This study was limited by its small sample size (36), the retrospective and nonrandomized nature of the case series, and a lack of routine postoperative imaging. A median follow-up length of 12.7 months may not be adequate to detect all recurrences. This case series supports the perineal approach for surgical repair; it should be the first approach considered, as it is less invasive and may be associated with shorter length of stay compared to an open transabdominal approach. Male gender and neoadjuvant chemotherapy may be possible risk factors for the development of perineal hernia after abdominoperineal resection. See Video Abstract at http://links.lww.com/DCR/B856. ANTECEDENTES:La hernia perineal es una complicación rara y bien conocida después de la resección abdominoperineal por cáncer de recto. Debido a su rareza, la literatura sobre su reparación quirúrgica se compone de informes de casos y pequeñas series de casos, y ningún abordaje quirúrgico se ha establecido como superior.OBJETIVO:El presente estudio tuvo como objetivo identificar los métodos de reparación utilizados en nuestra institución y sus resultados. Presumimos que un abordaje perineal tendría una tasa de recurrencia similar a una reparación transabdominal, con una estancia hospitalaria más corta.DISEÑO:Ésta es una serie de casos retrospectiva.AJUSTES:El escenario fue una gran institución única.PACIENTES:Los pacientes que se sometieron a reparación quirúrgica por hernia perineal desde enero del 2009 hasta diciembre del 2019 se incluyeron en la revisión.PRINCIPALES MEDIDAS DE RESULTADO:Los resultados primarios fueron la recurrencia de la hernia perineal, el abordaje quirúrgico para la reparación y la duración de la estadía.RESULTADOS:Identificamos 36 pacientes que fueron sometidos a reparación quirúrgica de hernia perineal en nuestra institución. La mayoría de los pacientes recibieron quimiorradioterapia neoadyuvante (n = 20). La mayoría de los pacientes (n = 29) se habrían sometido previamente a una resección abdominoperineal (n = 5 robótica, n = 15 laparoscópica, n = 1 robótica convertida a abierta, n = 8 abierta). Los pacientes fueron reparados mediante un abordaje perineal (n = 22) o transabdominal (n = 14). La mediana de la estancia hospitalaria fue de 4 días (rango, 1-12) después de un abordaje perineal y de 8 días (rango 3-18) después de un abordaje transabdominal. En una mediana de seguimiento de 12,7 meses (rango, 1-72) hubo 4 recurrencias después de la reparación perineal y 3 recurrencias después de la transabdominal.LIMITACIONES:El tamaño de la muestra pequeño (n = 36), la naturaleza retrospectiva y no aleatorizada de la serie de casos, la falta de imágenes posoperatorias de rutina, la mediana de seguimiento de 12,7 meses puede no ser adecuada para detectar todas las recurrencias.CONCLUSIONES:Esta serie de casos apoya el abordaje perineal para la reparación quirúrgica; debe ser el primer abordaje considerado, ya que es menos invasivo y puede estar asociado con una estadía más corta en comparación con el abordaje transabdominal abierto. El sexo masculino y la quimioterapia neoadyuvante podrían ser posibles factores de riesgo para el desarrollo de hernia perineal después de la resección abdominoperineal. Consulte Video Resumen en http://links.lww.com/DCR/B856. (Traducción- Dr. Francisco M. Abarca-Rendon).

Retrospective analysis of risk factors for postoperative perineal hernia after endoscopic abdominoperineal excision for rectal cancer

BackgroundIn contrast to open-surgery abdominoperineal excision (APE) for rectal cancer, postoperative perineal hernia (PPH) is reported to increase after extralevator APE and endoscopic surgery. In this study, therefore, we aimed to determine the risk factors for PPH after endoscopic APE.MethodsA total 73 patients who underwent endoscopic APE for rectal cancer were collected from January 2009 to March 2020, and the risk factors for PPH were analyzed retrospectively.ResultsNineteen patients (26%) developed PPH after endoscopic APE, and the diagnosis of PPH was made at 9–393 days (median: 183 days) after initial surgery. Logistic regression analysis showed that absence of pelvic peritoneal closure alone increased the incidence of PPH significantly (odds ratio; 13.76, 95% confidence interval; 1.48–1884.84, p = 0.004).ConclusionsThis preliminary study showed that pelvic peritoneal closure could prevent PPH after endoscopic APE.

Perineal hernia repair after extralevator abdominoperineal excision, how we do it (PERineal Laparoscopic Sling: PERLS Technique).

Recent shift to radical extralevator abdominoperineal excision (ELAPE) approach has seen an increased incidence of post-operative perineal hernia. However, there is no standardised surgical approach for its repair. The aim of this study was to report intra and post-operative results of the perineal hernia repair by the novel trans-abdominal PERineal Laparoscopic Sling (PERLS) Technique in patients who developed post-operative perineal hernia following ELAPE. This is a retrospective analysis of consecutive patients who underwent perineal hernia repair by laparoscopic PERLS approach. All patients had undergone ELAPE with vertical rectus abdominis muscle (VRAM) flap reconstruction during the index surgery for treatment of rectal cancer. Post-operative complications, operative time, conversion rate to open surgery and incidence of recurrent perineal hernia were noted. Seven patients were operated for perineal hernia. The mean operative time was 105min (range: 87 to 131min). One case needed conversion to the open approach. The incidence of early complications was 57.1% including just single Clavien-Dindo I and two Clavien-Dindo II complications, while recurrence rate was 14.3%. PERLS perineal hernia repair is safe, performed in convenient time duration (mean = 105min) and has reasonably less recurrence rate.

Perineal Hernia another Complication That Influences the Quality of Life after Amputation of the Rectum: Case Report

Introduction: Perineal eventration or perineal hernia is a protrusion of the pelvic floor containing intra-abdominal viscera. The occurrence of postoperative perineal hernia after abdominoperineal resection (APR) is rare, but has increased recently affecting the quality of life of the patient. Presentation of case: Here, we report a 68 -year-old women with history of myomectomy was diagnosed with a low rectal cancer. She has abdominoperineale resection after radiotherapy. She was operated for white line hernia 2 years after with mesh fixation. She presented to us 5 months after the operation, with perineal bulge and discomfort. The diagnosis of a perineal hernia was made clinically and was complemented by a CT scan. Abdominal CT scan showed that part of the small intestine was slightly protruding from a large defect of the pelvis. Discussion: Recurrence rates of perineal eventration has increased recently. Many approaches have been described, but there is still no consensus as to the optimal repair technique for perineal eventration. Conclusion: This case report confirm that perineal eventration is frequent in women such as literature with other risk factors like APR radiotherapy and a history of pelvic surgery.

Review of Postoperative Perineal Hernia and Available Reconstruction Techniques

Postoperative Perineal hernia (PerH) is a recognised rare complication of radical pelvic oncologic procedures for rectal cancer, with a reported prevalence of 0.6-7%. PerH is a swelling in the perineum caused by herniation of abdominal or pelvic viscera through a defect in the pelvic floor. The cause of postoperative PerH is not known, however, wide extent of dissection, wound infection, neoadjuvant radiotherapy, length of small bowel and wider female pelvis, have been identified as risk factors for development of postoperative PerH. Cause of PerH is not known. Universal case definition of PerH does not exist, except it is a bulge in the perineum. Patients who are fit for surgery, have no recurrency, and are bothered or have severe symptoms (perineal swelling, perineal skin necrosis, urinary problems and/or intestinal obstruction) are offered surgical treatment. The aim of surgical repair is to exclude recurrency, closure of the pelvic defect with reconstruction of a new pelvic floor and repair of hernia.

RECURRENT PERINEAL HERNIA — LAPAROSCOPIC SURGICAL TREATMENT: CLINICAL CASE

Background: Recurrent postoperative perineal hernia is a rare complication of such operation as posterior pelvic evisceration. This condition can reduce the quality of life in the postoperative period and requires surgical restoration of the impaired pelvic anatomy.Clinical case: A 54-year old female patient applied to the MSU University clinic in July 2020 with the protrusion in the perineal area. She was diagnosed with recurrent perineal postoperative hernia. She was diagnosed with rectal cancer T4N1M0 and uterine dysplasia in 2017, 6 courses of neoadjuvant polychemoradiation therapy were performed; she underwent extralevator abdominal-perineal resection with uterine extirpation and the permanent colostomy formation in 2018. A perineal postoperative hernia was diagnosed in March 2020, perineal transabdominal plastic surgery was performed with a mesh implant. A recurrent perineal hernia was diagnosed in April 2020, the patient underwent laparoscopic alloplasty with a composite mesh implant. On the 9th postoperative day, she was discharged in a satisfactory condition without any complaints.Conclusion: Postoperative perineal hernia is a fairly rare complication in surgical practice. The recurrent rate is quite high. The insufficient number of patients, the short follow-up period and the wide range of surgical treatment methods do not allow evaluating the results adequately. It is necessary to conduct large randomized clinical trials to assess the efficacy of surgical interventions and to determine the indications for certain procedures.

Pelvic peritoneum closure reduces postoperative complications of laparoscopic abdominoperineal resection: 6-year experience in single center.

To investigate feasibility of laparoscopic abdominoperineal resection with pelvic peritoneum closure (LAPR-PPC) for lower rectal cancer. LAPR-PPC has been used for lower rectal cancer in our institution since 2014. In this study, we retrospectively analyzed the data from 86 patients who underwent LAPR-PPC and compared with the data from 96 patients who underwent laparoscopic APR without PPC (LAPR) from January 2013 to December 2018. The rate of perineal surgical site infection (SSI) (18.75% (18/96) vs. 5.81% (5/86), p < 0.01), delayed (> 4weeks) perineal healing (12.50% (12/96) vs. 3.49% (3/86), p = 0.027), ileus (7.29% (7/96) vs 1.16% (1/86), p = 0.044), and postoperative perineal hernia (PPH, 5.21% (5/96) vs. 0% (0/86), p = 0.032) were significantly lower in LAPR-PPC group than LAPR group. The patients in LAPR-PPC group had shorter hospitalization time (21.32 ± 11.95days vs. 13.93 ± 11.51days, p < 0.01). PPC procedure enabled the reduction in perineal wound complications, ileus, PPH, and consequently shortened hospitalization time. LAPR-PPC is beneficial for the patients with lower rectal cancer.

PWE-387 Role of technique of abdomino-perineal excision of rectum on perineal complications and interventions - our experience

Introduction Oncological outcome from Extra-Levator Abdomino-Perineal Excision of low rectal cancers (ELAPE) have been shown to be superior to those achieved by conventional APER. However, it usually requires some form of pelvic floor repair due to the larger defect, and it has been suggested that ELAPE carries a higher morbidity particularly in view to pelvic floor complications. We examined results and outcomes from ELAPE and APER in our institution. Method All non-restorative excisions of primary low rectal cancers in a single colorectal unit between 2009 and 2014 were retrospectively examined, using data from healthcare records, pathology records and administrative databases. End points for analysis included duration of hospital stay following index surgery, rates of immediate (≤ 30 days) and late post-operative complications, re-admission rates, re-interventions and perineal hernia rates. Results A total of 44 patients underwent non-restorative excision of a rectal cancer (26 ELAPE and 18 APER), with a median follow up period of 30 months. There was no difference between the groups for age, gender, BMI, and rates of pre-operative neo-adjuvant treatment. However, there were more UICC stage III cancers in the ELAPE group compared to APER (5/26 [19.2%] vs. 11/18 [61.1%], p = 0.035). The median length of stay was similar in both groups (7.5 days, p = 0.44), and there was no difference between ELAPE and APER for early complication (12/26 [46.2%] vs. 7/18 [38.9%], p = 0.632), re-intervention (12/26 [46.2%] vs. 3/18 [16.7], p = 0.078), readmission (8/26 [30.8%] vs. 1/18 [5.6%], p = 0.071), and perineal hernia rates (1/26 [3.8%] vs. 1/18 [5.6%], p = 0.474). However, late perineal complications were more common in ELAPE (17/26 [65.4%] vs. 2/18 [11.1%], p Conclusion ELAPE appears to have no increased short-term morbidity compared to conventional APER, but late complication rates are higher. This may be, in part, explained by tumour factors, use of neo-adjuvant treatment and the use of mesh for reconstruction in this group. Selective use of ELAPE for non-restorative excision of a rectal cancer is advised, and the role of flap reconstruction may need to be considered in more patients. Disclosure of interest None Declared.

Composix meshを用いて修復した術後会陰ヘルニアの2例

Composix meshを用いて修復した術後会陰ヘルニアの2例

Laparoscopic and perineal approaches to perineal hernia repair

Perineal hernias after abdominoperineal resection (APER) of the rectum appear to be becoming more common, but there only a small number of reported cases, with very few reports discussing more than one or two. There is little consensus as to the optimal method of repair. We report the successful management of 7 cases of postoperative perineal hernia, including a hernia around a gluteal rotation flap that has not previously been reported, and discuss the operative approaches. We performed a single-centre hospital database review over 6years. Seven perineal hernias occurred after APER and were repaired. Six were treated with a transabdominal approach (5 laparoscopic and 1 laparoscopic converted to open) and one perineal approach. In 4 cases, a synthetic composite mesh was used, in 2 a biological mesh and in one direct suture repair. There have been no recurrences during a median follow-up of 25months. Laparoscopic mesh repair of symptomatic perineal hernia is the method of choice in most cases. Herniation may still occur despite inset of a gluteal rotation flap at initial APER and laparoscopic repair in that instance is difficult.

Recurrent Postoperative Perineal Hernia: Transperineal Redo Mesh Repair

Postoperative perineal hernia is a rare complication after abdominoperineal resection or pelvic exenteration. In this video article, we describe one technique of transperineal mesh repair of recurrent symptomatic perineal hernia after previous transabdominal mesh repair of the hernia developed after abdominoperineal resection. To date, this redo mesh repair is the only report that we could find in the English literature.

Éventration périnéale après proctectomie: Diagnostic et prise en charge

Postoperative perineal hernia is a rare complication following abdominoperineal excision of the rectum. We report four cases illustrating its clinical presentation and modern management. Surgical technique for rectal excision and perineal closure, making of an epiplooplasty, postoperative infection may contribute to the occurrence of this complication. Mesh repair through an anterior open or laparoscopic abdominal approach is one of the surgical options if not contraindicated by age and/or general condition. Perineal or combined approaches can also be selected to solve this difficult problem.

Hérnia perineal após disjunçao da sínfise púbica: apresentação de caso e técnica para correção

Traunatic perineal hernia remains a rare clinical entity despite an overall increase in blunt trauma. Because of the incidence of other associated injuries, the mortality is high. Most of the perineal defects are repaired during the orthopaedics surgery to reconstitute the pelvis and few patients develop a true perineal hernia without pelvic instability. A 80-year-old woman was involved in a running over accident with disjunction of pubic symphysis, dislocation of sacrum-iliac junction and fracture of pubis and ischium. The patient was submitted to an orthopaedic surgery and latter development an perineal hernia through the genitalia. The diagnosis could be established with physical examination alone. Conventional radiology, computadorized tomography, and ultrasound should also be done to progran the surgery. The repair approach was performed using a marlex mesh, fixed in the pelvic bones, Cooper ligament, and the abdominal wall. The mesh was stood in a retro- peritoneal position, rebuilding the pelvic floor without reconstruction the pelvic bones. We conclude that this is an efficient approach to repair of traumatic postoperative perineal hernia, mainly in patients with high operative risk, when the osseous repair is not necessary.

Postoperative perineal hernia.

Perineal hernia is an uncommon complication following abdominoperineal resection. The aim of the study was to evaluate the predisposing factors and the optimum method of repair. A retrospective review of patients with postoperative perineal hernia at the Massachusetts General Hospital between 1963 and 1995 was performed. Twenty-one patients with perineal hernias were found. The original perineal operations were as follows: abdominoperineal resection in 13 patients, pelvic exenteration in 5 patients, cystourethrectomy in 2 patients, and perineal resection of the rectal stump in 1 patient. The incidence of symptomatic perineal hernia following abdominoperineal resection was estimated to be 0.62 percent. A total of 69 percent of patients had the original perineal wound left partially open, and in 10 percent it was left completely open. The peritoneal defect was not closed in 53 percent of patients, and only 21 percent had closure of the levator defect. Of the 19 patients who had hernia repair, 13 were repaired transperineally and 3 transabdominally and 3 required a combined abdominoperineal approach. The repair methods were as follows: simple closure of the pelvic defect (10 patients), mesh closure (5 patients), gluteus flap (1 patient), and retroflexion of the uterus (2 patients) or bladder (1 patient). Four patients had postoperative complications (mostly wound infections), and the recurrence rate was 16 percent. There was no difference in length of hospitalization among transperineal, transabdominal, and combined approaches. Primary closure of the perineal wound, with careful avoidance of wound infection is the most important consideration for avoiding a perineal hernia. Repair via the perineum with simple closure of the defect or a mesh is successful in most cases.

Late evisceration of small bowel through postoperative perineal hernia after abdominoperinal resection: case report.

Late evisceration of small bowel through postoperative perineal hernia after abdominoperinal resection: case report.