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Li J, Wu L, Shao X, Cheng T. Postoperative perineal hernia repair: what is the evidence? Surg Today 2023; 53:1105-1115. [PMID: 36720743 DOI: 10.1007/s00595-023-02654-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/27/2022] [Indexed: 02/02/2023]
Abstract
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.
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Affiliation(s)
- Junsheng Li
- Department of General Surgery, Affiliated Zhongda Hospital, Southeast University, Nanjing, 210009, China.
| | - Lisheng Wu
- Department of Hernia and Bariatric SurgeryDivision of Life Science and MedicineAnhui Province, the First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, People's Republic of China
| | - Xiangyu Shao
- Department of General Surgery, Affiliated Zhongda Hospital, Southeast University, Nanjing, 210009, China
| | - Tao Cheng
- Department of General Surgery, Affiliated Zhongda Hospital, Southeast University, Nanjing, 210009, China
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2
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Soback H, Lahav L, Franko R, Avital S. A three layered repair of a large perineal hernia: case report and review of the literature. Surg Case Rep 2023; 9:58. [PMID: 37043143 PMCID: PMC10097843 DOI: 10.1186/s40792-023-01636-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 03/30/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND A symptomatic perineal hernia is an uncommon complication after abdominoperineal resection (APR). Repairs of such hernias can be achieved by usage of autologous flaps, synthetic mesh, or biologic mesh, which reduce bowel adhesions. Studies have shown that prophylactic repair of the pelvic floor with biologic mesh during APR, can reduce the incidence of perineal hernia. CASE PRESENTATION A 71-year-old woman, after extended APR (eAPR) with primary closure of pelvic floor with absorbable mesh, presented to our outpatient clinic with a symptomatic, extensive perineal hernia. The patient underwent repair of the perineal hernia using a synthetic mesh and a bilateral gluteal flap procedure. In post operative care, signs of surgical site infection and a fluid collection demonstrated in a CT-scan, compelled a surgical drainage. A clear fluid negative for bacterial growth was drained and antibiotic treatment was initiated. After drainage, surgical site showed signs of significant improvement and patient was eventually discharged. CONCLUSION The rise in reported incidence of perineal hernia after eAPR coupled with the scarcity of data regarding the preferable repair technique suggests that there is a significant need for further prospective comparative studies.
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Affiliation(s)
- Hagai Soback
- Surgery B Department, Meir Medical Center, Tchernichovsky St. 59, Kfar Saba, Israel.
| | - Lauren Lahav
- Surgery B Department, Meir Medical Center, Tchernichovsky St. 59, Kfar Saba, Israel
| | - Rotem Franko
- Surgery B Department, Meir Medical Center, Tchernichovsky St. 59, Kfar Saba, Israel
| | - Shmuel Avital
- Surgery B Department, Meir Medical Center, Tchernichovsky St. 59, Kfar Saba, Israel
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Mohammadyari F, Parvin S, Khorvash M, Amini A, Behzadi A, HajEbrahimi R, Kasaei F, Olangian-Tehrani S. Acellular dermal matrix in reconstructive surgery: Applications, benefits, and cost. FRONTIERS IN TRANSPLANTATION 2023; 2:1133806. [PMID: 38993878 PMCID: PMC11235262 DOI: 10.3389/frtra.2023.1133806] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 02/13/2023] [Indexed: 07/13/2024]
Abstract
Modern tissue engineering has made substantial advancements that have revolutionized plastic surgery. Acellular dermal matrix (ADM) is an example that has gained considerable attention recently. ADM can be made from humans, bovines, or porcine tissues. ADM acts as a scaffold that incorporates into the recipient tissue. It is gradually infiltrated by fibroblasts and vascularized. Fortunately, many techniques have been used to remove cellular and antigenic components from ADM to minimize immune system rejection. ADM is made of collagen, fibronectin, elastin, laminin, glycosaminoglycans, and hyaluronic acid. It is used in critical wounds (e.g., diabetic wounds) to protect soft tissue and accelerate wound healing. It is also used in implant-based breast reconstruction surgery to improve aesthetic outcomes and reduce capsule contracture risk. ADM has also gained attention in abdominal and chest wall defects. Some studies have shown that ADM is associated with less erosion and infection in abdominal hernias than synthetic meshes. However, its higher cost prevents it from being commonly used in hernia repair. Also, using ADM in tendon repair (e.g., Achilles tendon) has been associated with increased stability and reduced rejection rate. Despite its advantages, ADM might result in complications such as hematoma, seroma, necrosis, and infection. Moreover, ADM is expensive, making it an unsuitable option for many patients. Finally, the literature on ADM is insufficient, and more research on the results of ADM usage in surgeries is needed. This article aims to review the literature regarding the application, Benefits, and costs of ADM in reconstructive surgery.
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Affiliation(s)
| | - Sadaf Parvin
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohsen Khorvash
- School of Medicine, Islamic Azad University of Medical Sciences, Tehran, Iran
| | - Amirhasan Amini
- School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | | | | | - Fatemeh Kasaei
- School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Sepehr Olangian-Tehrani
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Avicennet, Tehran, Iran
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Surgical technique for primary perineal hernia repair: a systematic scoping review. Hernia 2023:10.1007/s10029-023-02760-9. [PMID: 36840829 DOI: 10.1007/s10029-023-02760-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/12/2023] [Indexed: 02/26/2023]
Abstract
PURPOSE A perineal hernia is a subtype of pelvic floor hernias, and especially primary perineal hernias are rare. No guideline exists on how to handle this type of hernia. Therefore, the primary aim of this scoping review was to investigate the surgical treatment options in adults for primary perineal hernias. METHODS This systematic scoping review included studies with original data on at least one adult operated for a primary perineal hernia. Studies from 1990 and forward were included to cover contemporary surgical techniques. Three databases were systematically searched: PubMed, Embase, and Cochrane CENTRAL. Furthermore, a snowball search was performed. The primary outcome was to narratively present details about the surgical techniques. The secondary outcomes were to give an overview of symptoms, diagnostics, intraoperative complications, and postoperative course. RESULTS Twenty-two case studies reported repairs on 22 patients suffering from primary perineal hernia. Common symptoms were pain and discomfort, and a bulge was often found during physical examination. Different diagnostic methods were used, and MRI-scans most often found an abnormality. Different surgical procedures can repair the condition, however, laparotomy and the use of a permanent mesh was the most common option. Far from all studies reported on outcomes, but no severe intraoperative event was reported, and the postoperative course was overall uneventful. CONCLUSION Primary perineal hernia is a very rare condition presenting with pain/discomfort and bulging and it can be visualized with different imaging modalities. Laparotomy with a permanent mesh was often used for repair, and the postoperative course was mostly uneventful.
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Salati SA, Arkoubi A. Perineal hernia after abdominoperineal resection – a systematic review. POLISH JOURNAL OF SURGERY 2022; 94:61-70. [DOI: 10.5604/01.3001.0015.7677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
<b>Introduction:</b> Perineal hernia (PH), also termed pelvic floor hernia, is a protrusion of intraabdominal viscera into the perineum through a defect in the pelvic floor. </br></br> <b>Aim:</b> The study was conducted to evaluate the cases of perineal hernia resulting as a complication of abdominoperineal resection (APR) of rectal cancer. </br></br> <b> Material and methods:</b> 30 cases from 24 articles published in reputable peer reviewed journals were evaluated for eight variables including [I] patient age, [II] gender, [III] time since APR, [IV] clinical presentation, [V] approach to repair, [VI] type of repair, [VII] presence/absence of pelvic adhesions [VIII] complications. </br></br> <b>Results:</b> There was a total of 30 cases (18 males and 12 females) with a mean age of 71.5 years. The time of onset of symptoms ranged from 6 days to 12 years. Perineal lump with pain was the chief presenting feature followed by intestinal obstruction. Different approaches were adopted to repair by various methods. </br></br> <b>Conclusions:</b> Perineal hernia as a complication of abdominoperineal resection is reported increasingly nowadays, as the approach to management of rectal cancer has gradually got shifted from open to minimally invasive in recent years. There is a need to spread awareness about this condition, so that it is actively looked for, during the postoperative follow-up. Management is surgical repair; the approach and type of repair should be individualized.
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Affiliation(s)
- Sajad Ahmad Salati
- Unaizah College of Medicine & Medical Sciences, Qassim University, Saudi Arabia
| | - Amr Arkoubi
- College of Medicine, Imam Muhammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
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Abstract
A 72-year-old male patient presented to our outpatient clinic complaining with a perineal bulge one year after abdominoperineal excision for rectal cancer. He described a progressively enlarging bulge in the perineum causing a dull pain that was worse when sitting. On examination, the skin was intact, and a soft 7-cm hernia was identified that could be reduced into the pelvis but recurred immediately. Treatment options were discussed.
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7
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Blok RD, Sharabiany S, Stoker J, Laan ETM, Bosker RJI, Burger JWA, Chaudhri S, van Duijvendijk P, van Etten B, van Geloven AAW, de Graaf EJR, Hoff C, Hompes R, Leijtens JWA, Rothbarth J, Rutten HJT, Singh B, Vuylsteke RJCLM, de Wilt JHW, Dijkgraaf MGW, Bemelman WA, Musters GD, Tanis PJ. Cumulative 5-year Results of a Randomized Controlled Trial Comparing Biological Mesh With Primary Perineal Wound Closure After Extralevator Abdominoperineal Resection (BIOPEX-study). Ann Surg 2022; 275:e37-e44. [PMID: 33534231 DOI: 10.1097/sla.0000000000004763] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine long-term outcomes of a randomized trial (BIOPEX) comparing biological mesh and primary perineal closure in rectal cancer patients after extralevator abdominoperineal resection and preoperative radiotherapy, with a primary focus on symptomatic perineal hernia. SUMMARY BACKGROUND DATA BIOPEX is the only randomized trial in this field, which was negative on its primary endpoint (30-day wound healing). METHODS This was a posthoc secondary analysis of patients randomized in the BIOPEX trial to either biological mesh closure (n = 50; 2 dropouts) or primary perineal closure (n = 54; 1 dropout). Patients were followed for 5 years. Actuarial 5-year probabilities were determined by the Kaplan-Meier statistic. RESULTS Actuarial 5-year symptomatic perineal hernia rates were 7% (95% CI, 0-30) after biological mesh closure versus 30% (95% CI, 10-49) after primary closure (P = 0.006). One patient (2%) in the biomesh group underwent elective perineal hernia repair, compared to 7 patients (13%) in the primary closure group (P = 0.062). Reoperations for small bowel obstruction were necessary in 1/48 patients (2%) and 5/53 patients (9%), respectively (P = 0.208). No significant differences were found for chronic perineal wound problems, locoregional recurrence, overall survival, and main domains of quality of life and functional outcome. CONCLUSIONS Symptomatic perineal hernia rate at 5-year follow-up after abdominoperineal resection for rectal cancer was significantly lower after biological mesh closure. Biological mesh closure did not improve quality of life or functional outcomes.
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Affiliation(s)
- Robin D Blok
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- LEXOR, Center for Experimental and Molecular Medicine, Oncode Institute, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Sarah Sharabiany
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Jaap Stoker
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, the Netherlands
| | - Ellen T M Laan
- Department of Sexology and Psychosomatic Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | | | - Sanjay Chaudhri
- Department of Surgery, University Hospitals Leicester, Leicester, United Kingdom
| | | | - Boudewijn van Etten
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Eelco J R de Graaf
- Department of Surgery, IJsselland Hospital, Capelle aan de IJssel, the Netherlands
| | - Christiaan Hoff
- Department of Surgery, Medical Center Leeuwarden, Leeuwarden, the Netherlands
| | - Roel Hompes
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Joost Rothbarth
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Harm J T Rutten
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Baljit Singh
- Department of Surgery, University Hospitals Leicester, Leicester, United Kingdom
| | | | - Johannes H W de Wilt
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marcel G W Dijkgraaf
- Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Willem A Bemelman
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Gijsbert D Musters
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Pieter J Tanis
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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8
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Sharabiany S, Strijk GJ, Blok RD, Ferrett CG, Stoker J, Cunningham C, van der Bilt JDW, van Geloven AAW, Bemelman WA, Hompes R, Musters GD, Tanis PJ. Quantifying displacement of urogenital organs after abdominoperineal resection for rectal cancer. Colorectal Dis 2021; 23:2923-2931. [PMID: 34427972 PMCID: PMC9291959 DOI: 10.1111/codi.15885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 08/11/2021] [Accepted: 08/13/2021] [Indexed: 02/08/2023]
Abstract
AIM This study aimed to quantify displacement of urogenital organs after abdominoperineal resection (APR), and to explore patient and treatment characteristics associated with displacement. METHOD Patients from 16 centres who underwent APR for primary or recurrent rectal cancer (2001-2018) with evaluable preoperative and 6-18 months postoperative radiological imaging were included in the study. Anatomical landmarks on sagittal images were related to a coordinate system based on reference lines between fixed bony structures and absolute displacements were calculated using the Pythagorean theorem. Rotation of landmarks was measured relative to a pubic-S5 reference line. RESULTS There were 248 patients included of which 171 were men and 77 women. The median displacement of the internal urethral orifice was 25 mm in men (maximum 65), and 17 mm in women (maximum 50). Rotation of the internal urethral orifice was in a caudal direction in 160/170 (94%) of men and 65/73 (89%) of women, with a median of 32 degrees (maximum 85) and 33 degrees (maximum 83), respectively. Displacements of the posterior bladder wall, distal end of prostatic urethra and cervix were significantly correlated with the internal urethral orifice. In linear regression analysis, biological mesh reconstruction of the pelvic floor and visceral interposition were significantly associated with increased displacement of the internal urethral orifice, and female gender and any filling of the presacral space with decreased displacement. CONCLUSIONS Substantial absolute displacement and rotation of urogenital organs after APR for rectal cancer were observed, but with high variability among both men and women, and being significantly associated with reconstructive interventions.
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Affiliation(s)
- Sarah Sharabiany
- Department of SurgeryAmsterdam University Medical CentresUniversity of AmsterdamAmsterdamThe Netherlands
| | - Gaby J. Strijk
- Department of SurgeryAmsterdam University Medical CentresUniversity of AmsterdamAmsterdamThe Netherlands
| | - Robin D. Blok
- Department of SurgeryAmsterdam University Medical CentresUniversity of AmsterdamAmsterdamThe Netherlands
| | - Colin G. Ferrett
- Department of RadiologyOxford University Hospitals NHS Foundation TrustOxfordUK
| | - Jaap Stoker
- Department of RadiologyAmsterdam University Medical CentresUniversity of AmsterdamAmsterdamThe Netherlands
| | - Christopher Cunningham
- Department of Colorectal SurgeryChurchill HospitalOxford University Hospitals NHS Foundation TrustOxfordUK
| | | | | | - Wilhelmus A. Bemelman
- Department of SurgeryAmsterdam University Medical CentresUniversity of AmsterdamAmsterdamThe Netherlands
| | - Roel Hompes
- Department of SurgeryAmsterdam University Medical CentresUniversity of AmsterdamAmsterdamThe Netherlands
| | - Gijsbert D. Musters
- Department of SurgeryAmsterdam University Medical CentresUniversity of AmsterdamAmsterdamThe Netherlands
| | - Pieter J. Tanis
- Department of SurgeryAmsterdam University Medical CentresUniversity of AmsterdamAmsterdamThe Netherlands
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Johal KS, Mishra A, Alkizwini E, Whitehouse H, Batten G, Hachach-Haram N, Lancaster K, Constantinides J, Mohanna PN, Roblin P, Ross DA. Immediate vaginal and perineal reconstruction after abdominoperineal excision using the Inferior Gluteal Artery Perforator Flap (V-IGAP). J Plast Reconstr Aesthet Surg 2021; 75:137-144. [PMID: 34657821 DOI: 10.1016/j.bjps.2021.08.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 06/24/2021] [Accepted: 08/26/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The fasciocutaneous inferior gluteal artery perforator (IGAP) has been previously demonstrated to be a robust reconstructive choice after abdominoperineal excision (APE), with comparably low morbidity relative to other flaps. In patients who undergo concurrent vaginectomy, we demonstrate in this retrospective cohort study how IGAP modification allows simultaneous vaginal reconstruction with a favourable complication profile and long-term return to sexual activity. METHODS Oncological resection was completed with the patient prone. Unilateral or bilateral IGAP flaps may be used based on vaginal defect size and surgeon preference. In this study, important features of flap design, mobilisation and inset are presented, together with a retrospective cohort study of all cases who underwent vaginal reconstruction. Clinical outcomes were determined by the length of stay, early to late complications, and quality of life assessment including a return to sexual function. RESULTS Over a 10-year period, 207 patients underwent abdominoperineal resection (APE) in our cross-centre study (86% subject to neoadjuvant chemoradiotherapy), with 22/84 female patients electing for vaginal reconstruction (19 partial, 3 total vaginectomies). Minor complications were observed in 6/22 cases, with two patients progressing to healing after-theatre debridement (major). The median follow-up time was 410 days. Quality of life questionnaires reported high patient satisfaction, with 70% of patients returning to sexual activity. CONCLUSIONS For patients undergoing APE with concurrent vaginectomy, the IGAP flap can be used alone for both perineal dead space management and neovaginal reconstruction, negating the need for an alternative second flap and avoiding significant donor morbidity. This study shows excellent long-term clinical outcomes, including a return to sexual activity.
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Affiliation(s)
- Kavan S Johal
- Department of Plastic Surgery, St Thomas' Hospital, London, United Kingdom.
| | - Ankit Mishra
- Department of Plastic Surgery, St Thomas' Hospital, London, United Kingdom
| | - Eman Alkizwini
- Department of Colorectal Surgery, St Mark's Hospital, Middlesex, United Kingdom
| | - Harry Whitehouse
- Department of Plastic Surgery, St Thomas' Hospital, London, United Kingdom
| | - Gemma Batten
- Department of Plastic Surgery, St Thomas' Hospital, London, United Kingdom
| | | | - Katie Lancaster
- Department of Plastic Surgery, St Thomas' Hospital, London, United Kingdom
| | - Joannis Constantinides
- Department of Plastic Surgery, St Thomas' Hospital, London, United Kingdom; Department of Plastic Surgery, St Mark's Hospital, Middlesex, United Kingdom
| | - Pari-Naz Mohanna
- Department of Plastic Surgery, St Thomas' Hospital, London, United Kingdom
| | - Paul Roblin
- Department of Plastic Surgery, St Thomas' Hospital, London, United Kingdom
| | - David A Ross
- Department of Plastic Surgery, St Thomas' Hospital, London, United Kingdom; Department of Plastic Surgery, St Mark's Hospital, Middlesex, United Kingdom
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Zaheer Ahmad N, Abbas MH, Al-Naimi NMAB, Parvaiz A. Meta-analysis of biological mesh reconstruction versus primary perineal closure after abdominoperineal excision of rectal cancer. Int J Colorectal Dis 2021; 36:477-492. [PMID: 33392663 DOI: 10.1007/s00384-020-03827-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/18/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Extralevator abdominoperineal excision (ELAPE) of rectal cancer has been proposed to achieve better oncological outcomes. The resultant wide perineal wound, however, presents a challenge for primary closure and subsequent wound healing. This meta-analysis compared the outcomes of primary perineal closure with those of biological mesh reconstruction. METHODS The Medline and Embase search was performed for the publications comparing primary perineal closure to biological mesh reconstruction. Early perineal wound complications (seroma, infection, dehiscence) and late perineal wound complications (perineal hernia, chronic pain, and chronic sinus) were analyzed as primary endpoints. Intraoperative blood loss, operation time, and hospital stay were compared as secondary endpoints. RESULTS There was no significant difference in the overall early wound complications after primary closure or biological mesh reconstruction (odds ratio (OR) of 0.575 with 95% confidence interval (CI) of 0.241 to 1.373 and a P value of 0.213). The incidence of perineal hernia after 1 year was significantly high after primary closure of the perineal wounds (OR of 0.400 with 95% CI of 0.240 to 0.665 and a P value of 0.001). No significant differences were observed among other early and late perineal wound complications. The operation time and hospital stay were shorter after primary perineal closure (p 0.001). CONCLUSION A lower incidence of perineal hernia and comparable early perineal wound complications after biological mesh reconstruction show a relative superiority over primary closure. More randomized studies are required before a routine biological mesh reconstruction can be recommended for closure of perineal wounds after ELAPE.
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Affiliation(s)
- Nasir Zaheer Ahmad
- Department of Surgery, University Hospital Limerick, St Nessan's Rd, Dooradoyle, Co., Limerick, V94 F858, Republic of Ireland.
| | - Muhammad Hasan Abbas
- Department of Surgery, Russells Hall Hospital NHS Trust, Pensnett Rd, West Midlands, Dudley, DY1 2HQ, UK
| | | | - Amjad Parvaiz
- Faculty of Health Sciences, University of Portsmouth, Portsmouth, UK.,Colorectal Department, Poole NHS Trust Poole UK, Poole, UK
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11
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Rajebhosale R, Miah M, Currie F, Thomas P. Closed loop obstruction and adhesive intestinal obstruction in perineal hernia. BMJ Case Rep 2020; 13:13/12/e238112. [PMID: 33372017 PMCID: PMC7771582 DOI: 10.1136/bcr-2020-238112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Perineal hernia with bowel gangrene is uncommon but known complication of laparoscopic extralevator abdominoperineal excision (ELAPE). We present a rare case of closed loop small bowel obstruction with bowel gangrene secondary to an incarcerated perineal hernia that developed 7 years after an ELAPE. Intraoperatively, we found a definitive transition point due to adhesions in pelvis and a closed loop obstruction of the distal small bowel at different site with gangrenous intestine. She was managed successfully surgically with adhesiolysis and fixation of defect with biological mesh. Prevalence of perineal hernias will rise in future because of the increasing cases of ELAPE, in which no repair of pelvic floor is performed. The need of follow-up of these operations and more reporting of such cases are important in increasing awareness of these complications. Patients should be made aware of such complications and should seek urgent medical care.
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Affiliation(s)
- Ramprasad Rajebhosale
- General Surgery, University Hospitals of Derby and Burton NHS Foundation Trust, Burton upon Trent, UK
| | - Mohammad Miah
- General Surgery, University Hospitals of Derby and Burton NHS Foundation Trust, Burton upon Trent, UK
| | - Fraser Currie
- General Surgery, University Hospitals of Derby and Burton NHS Foundation Trust, Burton upon Trent, UK
| | - Pradeep Thomas
- General Surgery, University Hospitals of Derby and Burton NHS Foundation Trust, Burton upon Trent, UK
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12
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Galliamov EA, Agapov MA, Markaryan DR, Kakotkin VV, Kazachenko EA, Kubyshkin VA. RECURRENT PERINEAL HERNIA — LAPAROSCOPIC SURGICAL TREATMENT: CLINICAL CASE. SURGICAL PRACTICE 2020. [DOI: 10.38181/2223-2427-2020-3-59-64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
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.
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Affiliation(s)
- E. A. Galliamov
- Federal State Budget Educational Institution of Higher Education M. V. Lomonosov Moscow State University (Lomonosov MSU); Federal State Autonomous Educational Institution of Higher Education I. M. Sechenov First Moscow State Medical University (Sechenov University)
| | - M. A. Agapov
- Federal State Budget Educational Institution of Higher Education M. V. Lomonosov Moscow State University (Lomonosov MSU)
| | - D. R. Markaryan
- Federal State Budget Educational Institution of Higher Education M. V. Lomonosov Moscow State University (Lomonosov MSU)
| | - V. V. Kakotkin
- Federal State Budget Educational Institution of Higher Education M. V. Lomonosov Moscow State University (Lomonosov MSU)
| | - E. A. Kazachenko
- Federal State Budget Educational Institution of Higher Education M. V. Lomonosov Moscow State University (Lomonosov MSU)
| | - V. A. Kubyshkin
- Federal State Budget Educational Institution of Higher Education M. V. Lomonosov Moscow State University (Lomonosov MSU)
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Jafari M, Schneider-Bordat L, Hersant B. Biological mesh used to repair perineal hernias following abdominoperineal resection for anorectal cancer. ANN CHIR PLAST ESTH 2020; 65:e15-e21. [PMID: 32517871 DOI: 10.1016/j.anplas.2019.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 11/20/2019] [Accepted: 12/02/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE This study aimed to determine the outcome for patients who had undergone perineal hernia repair, via a perineal approach, using a biological mesh post-abdominoperineal excision (APE) for anorectal cancer. METHOD All consecutive patients having undergone perineal hernia repair involving an extracellular matrix of porcine small intestinal submucosa at our hospital between 2015 and 2018 were included. Follow-up clinical examinations and computed tomography scans were performed. RESULTS Six patients were treated surgically for symptomatic perineal hernia after a median of 31 months from APE. The median follow-up after hernia repair was 11 months (interquartile range [IQR], 6-35 months). Three patients (50%) developed a recurrent perineal hernia after a median interval of 6 months. CONCLUSION Perineal hernia repair using a biological mesh resulted in a high recurrence rate in patients who had undergone APE for anorectal cancer.
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Affiliation(s)
- M Jafari
- Service de chirurgie oncologique, centre Oscar-Lambret, 3, rue Combemale, 59020 Lille cedex, France.
| | - L Schneider-Bordat
- Service de chirurgie oncologique, centre Oscar-Lambret, 3, rue Combemale, 59020 Lille cedex, France
| | - B Hersant
- Service de chirurgie plastique, reconstructrice, esthétique, et maxillo-faciale, hôpitaux universitaires Henri-Mondor, 51, avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
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14
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Koh CE. Getting to the 'bottom' of perineal hernias. Colorectal Dis 2020; 22:609-610. [PMID: 32542905 DOI: 10.1111/codi.15142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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15
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Blok RD, Brouwer TPA, Sharabiany S, Musters GD, Hompes R, Bemelman WA, Tanis PJ. Further insights into the treatment of perineal hernia based on a the experience of a single tertiary centre. Colorectal Dis 2020; 22:694-702. [PMID: 31910492 PMCID: PMC7318248 DOI: 10.1111/codi.14952] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 12/03/2019] [Indexed: 12/12/2022]
Abstract
AIM There is little evidence concerning the optimal surgical technique for the repair of perineal hernia. This study aimed to report on the evolution of a technique for repair of perineal hernia by analysing the experience in a tertiary referral centre. METHOD This was a retrospective review of consecutive patients who underwent perineal hernia repair after abdominoperineal excision in a tertiary referral centre. The main study end-points were rate of recurrent perineal hernia, perineal wound complications and related re-intervention. RESULTS Thirty-four patients were included: in 18 patients a biological mesh was used followed by 16 patients who underwent synthetic mesh repair. Postoperative perineal wound infection occurred in two patients (11%) after biological mesh repair compared with four (25%) after synthetic mesh repair (P = 0.387). None of the meshes were explanted. Recurrent perineal hernia following biological mesh was found in 7 of 18 patients (39%) after a median of 33 months. The recurrence rate with a synthetic mesh was 5 of 16 patients (31%) after a median of 17 months (P = 0.642). Re-repair was performed in four (22%) and two patients (13%), respectively (P = 0.660). Eight patients required a transposition flap reconstruction to close the perineum over the mesh, and no recurrent hernias were observed in this subgroup (P = 0.030). No mesh-related small bowel complications occurred. CONCLUSION Recurrence rates after perineal hernia repair following abdominoperineal excision were high, and did not seem to be related to the type of mesh. If a transposition flap was added to the mesh repair no recurrences were observed, but this finding needs confirmation in larger studies.
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Affiliation(s)
- R. D. Blok
- Department of SurgeryAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands,LEXORCentre for Experimental and Molecular MedicineOncode InstituteCancer Centre AmsterdamAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - T. P. A. Brouwer
- Department of SurgeryAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - S. Sharabiany
- Department of SurgeryAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - G. D. Musters
- Department of SurgeryAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - R. Hompes
- Department of SurgeryAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - W. A. Bemelman
- Department of SurgeryAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - P. J. Tanis
- Department of SurgeryAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
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16
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CT assessment of the quality of omentoplasty and its implications for perineal wound healing. Int J Colorectal Dis 2019; 34:1963-1970. [PMID: 31686200 DOI: 10.1007/s00384-019-03412-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/23/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE This study was designed to examine the impact of an omentoplasty and its quality on pelviperineal morbidity after abdominoperineal resection (APR) for rectal cancer. METHODS This was a retrospective single-centre study of consecutive patients undergoing APR for primary or recurrent rectal cancer between 2000 and 2018. Quality of omentoplasty was categorised (sufficient vs insufficient) based on postoperative CT scans. Main study endpoints were perineal wound healing and perineal hernia. RESULTS This study included 100 patients: 16 with a sufficient omentoplasty, 16 with an insufficient omentoplasty, and 68 without omentoplasty. Rate of pelviperineal complications within 30 days was 44%, 69% and 64% (P = 0.283), and delayed wound healing at 3 months was 19%, 54% and 27%, respectively (P = 0.109). Sufficient omentoplasty was not significantly associated with less delayed healing in multivariable analysis (OR 0.597; 95% CI 0.149-2.397). An insufficient omentoplasty demonstrated significantly higher rates of delayed healing at 6 months (46% vs 14%; P = 0.016) and chronic perineal sinus at 12 months (31% vs 3%; P = 0.008) compared with no omentoplasty. CONCLUSION This relatively small series suggest that even a sufficient omentoplasty, as determined by postoperative imaging, does not reduce pelviperineal morbidity after APR for rectal cancer. The methodology of CT-based assessment of an omentoplasty as well as the correlation with postoperative outcomes has to be validated in future studies.
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17
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Tork S, Jefferson RC, Janis JE. Acellular Dermal Matrices: Applications in Plastic Surgery. Semin Plast Surg 2019; 33:173-184. [PMID: 31384233 DOI: 10.1055/s-0039-1693019] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Modern advances in tissue engineering have transformed the plastic surgeon's management strategies across a wide variety of applications. Comprehension of the fundamentals of biologic constructs is critical to navigating the available armamentarium. It is essential that plastic surgeons become familiar with some of the existing methods for utilizing biologics as well as the advantages and limitations to their use. In this article, the authors describe the basic science of biologics with a focus on acellular dermal matrices (ADMs), and review the recent evidence behind their use for a variety of reconstructive and aesthetic purposes. The review is organized by system and examines the common indications, techniques, and outcomes pertaining to the application of ADMs in select anatomic areas. The final section briefly considers possible future directions for using biologics in plastic and reconstructive surgery.
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Affiliation(s)
- Shahryar Tork
- Department of Plastic and Reconstructive Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Ryan C Jefferson
- Department of Plastic and Reconstructive Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Jeffrey E Janis
- Department of Plastic Surgery, University Hospitals, Wexner Medical Center, Ohio State University, Columbus, Ohio
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18
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Lee E, Kim HJ, Shaker MR, Ryu JR, Ham MS, Seo SH, Kim DH, Lee K, Jung N, Choe Y, Son GH, Rhyu IJ, Kim H, Sun W. High-Performance Acellular Tissue Scaffold Combined with Hydrogel Polymers for Regenerative Medicine. ACS Biomater Sci Eng 2019; 5:3462-3474. [PMID: 33405730 DOI: 10.1021/acsbiomaterials.9b00219] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Decellularization of tissues provides extracellular matrix (ECM) scaffolds for regeneration therapy and an experimental model to understand ECM and cellular interactions. However, decellularization often causes microstructure disintegration and reduction of physical strength, which greatly limits the use of this technique in soft organs or in applications that require maintenance of physical strength. Here, we present a new tissue decellularization procedure, namely CASPER (Clinically and Experimentally Applicable Acellular Tissue Scaffold Production for Tissue Engineering and Regenerative Medicine), which includes infusion and hydrogel polymerization steps prior to robust chemical decellularization treatments. Polymerized hydrogels serve to prevent excessive damage to the ECM while maintaining the sophisticated structures and biological activities of ECM components in various organs, including soft tissues such as brains and embryos. CASPERized tissues were successfully recellularized to stimulate a tissue-regeneration-like process after implantation without signs of pathological inflammation or fibrosis in vivo, suggesting that CASPERized tissues can be used for monitoring cell-ECM interactions and for surrogate organ transplantation.
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Affiliation(s)
- Eunsoo Lee
- Department of Anatomy and Division of Brain Korea 21 Plus Program for Biomedical Science, Korea University College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Hyun Jung Kim
- Department of Anatomy and Division of Brain Korea 21 Plus Program for Biomedical Science, Korea University College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Mohammed R Shaker
- Department of Anatomy and Division of Brain Korea 21 Plus Program for Biomedical Science, Korea University College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Jae Ryun Ryu
- Department of Anatomy and Division of Brain Korea 21 Plus Program for Biomedical Science, Korea University College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Min Seok Ham
- Department of Dermatology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Soo Hong Seo
- Department of Dermatology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Dai Hyun Kim
- Department of Anatomy and Division of Brain Korea 21 Plus Program for Biomedical Science, Korea University College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul 02841, Republic of Korea.,Department of Dermatology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kiwon Lee
- Logos Biosystems, Inc., Anyang-si, Gyunggi-do 431-755, Republic of Korea
| | - Neoncheol Jung
- Logos Biosystems, Inc., Anyang-si, Gyunggi-do 431-755, Republic of Korea
| | - Youngshik Choe
- Department of Neural Development and Disease, Korea Brain Research Institute, Daegu 701-300, Republic of Korea
| | - Gi Hoon Son
- Department of Biomedical Sciences and Department of Legal Medicine, Korea University College of Medicine, Seoul 02841, Republic of Korea
| | - Im Joo Rhyu
- Department of Anatomy and Division of Brain Korea 21 Plus Program for Biomedical Science, Korea University College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Hyun Kim
- Department of Anatomy and Division of Brain Korea 21 Plus Program for Biomedical Science, Korea University College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Woong Sun
- Department of Anatomy and Division of Brain Korea 21 Plus Program for Biomedical Science, Korea University College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
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19
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Bertrand K, Lefevre JH, Creavin B, Luong M, Debove C, Voron T, Chafai N, Tiret E, Parc Y. The management of perineal hernia following abdomino-perineal excision for cancer. Hernia 2019; 24:279-286. [PMID: 30887380 DOI: 10.1007/s10029-019-01927-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 03/11/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE Perineal hernia (PH) is a tardive complication following abdomino-perineal resection (APR). Many repair methods are described and evidences are lacking. The aim of this study was to report PH management, analyze surgery outcomes and review the available literature. METHODS We retrospectively included all consecutive PH repair after APR performed between 2001 and 2017. We recorded data on APR surgery, PH symptoms and repair, and follow-up (recurrence and morbidity). Literature review included published articles on PubMed between 1960 and 2017. RESULTS 24 PH repairs were included. The approach was perineal N = 16, abdominal N = 5 and combined N = 3. A biological mesh was used for 17, a synthetic for 5 and a flap for 2 patients. The median follow-up was 25 months. Overall morbidity was 37.5% (N = 9): 37.5% for the perineal, 20% for the abdominal, and 66.7% for the combined approach. Complications occurred in 35.3% of biological and 20% of synthetic mesh repairs. Recurrence rate was 41.7%, similar for biological (n = 8, 47.1%) and synthetic meshs (n = 2; 40%). No recurrence occurred in the flap group. Depending of the approach, we found 50% for perineal (n = 8) and 40% of the abdominal cohort (N = 2). Among twelve studies, recurrence rates ranged from 0 to 66.7%. Abdominal or laparoscopic approach with synthetic mesh was associated with less recurrences (0 and 12.5% respectively) and complications (37.5% and 9.5%). CONCLUSIONS Recurrences following PH repair are high irrespective of the repair technique. More studies are necessary to identify PH risk factors and decide the appropriate perineal reconstruction.
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Affiliation(s)
- K Bertrand
- Departments of Digestive and General Surgery, Hospital Saint-Antoine AP-HP, Sorbonne Université, Paris, France
| | - J H Lefevre
- Departments of Digestive and General Surgery, Hospital Saint-Antoine AP-HP, Sorbonne Université, Paris, France.
| | - B Creavin
- Department of Surgery, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - M Luong
- Departments of Digestive and General Surgery, Hospital Saint-Antoine AP-HP, Sorbonne Université, Paris, France
| | - C Debove
- Departments of Digestive and General Surgery, Hospital Saint-Antoine AP-HP, Sorbonne Université, Paris, France
| | - T Voron
- Departments of Digestive and General Surgery, Hospital Saint-Antoine AP-HP, Sorbonne Université, Paris, France
| | - N Chafai
- Departments of Digestive and General Surgery, Hospital Saint-Antoine AP-HP, Sorbonne Université, Paris, France
| | - E Tiret
- Departments of Digestive and General Surgery, Hospital Saint-Antoine AP-HP, Sorbonne Université, Paris, France
| | - Y Parc
- Departments of Digestive and General Surgery, Hospital Saint-Antoine AP-HP, Sorbonne Université, Paris, France
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20
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Balla A, Batista Rodríguez G, Buonomo N, Martinez C, Hernández P, Bollo J, Targarona EM. Perineal hernia repair after abdominoperineal excision or extralevator abdominoperineal excision: a systematic review of the literature. Tech Coloproctol 2017; 21:329-336. [PMID: 28508281 DOI: 10.1007/s10151-017-1634-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 05/01/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND The incidence of perineal hernia after abdominoperineal excision and extralevator abdominoperineal excision ranges from 1 to 26%. In this systematic review, we compared surgical options and postoperative outcomes of perineal hernia repair in this setting from 2012 to 2016 with findings in a review of publications 1944-2011. METHODS We searched the PubMed database using the keywords "hernia" AND "perineum" identified 392 papers published from 1946 to 2016. Two hundred and ninety-six papers published before 2012 were excluded and 96 were found to be potentially relevant. RESULTS Twenty-one studies with a total of 108 patients were included in the final analysis. Perineal hernia repair was performed using the perineal approach in 75 patients (69.44%), the laparoscopic approach in 25 patients (23.14%), the open abdominal approach in three patients (2.77%) and the laparoscopic perineal approach in three patients (2.77%) and the open abdominoperineal approach in two patients (1.8%). Non-absorbable mesh was used in 41 (37.96%) of cases, composite mesh in 20 (18.51%) and biological mesh in 19 (17.59%). Flap reconstruction was used in 25 patients (23.14%). First and second recurrences were observed in 26 (24.07%) and 7 (26.92%) cases, respectively. CONCLUSIONS Comparison of perineal hernia repair from 1944 to 2011 and from 2012 to 2016 showed that perineal and laparoscopic approaches are currently the most commonly used techniques. Primary defect closure was abandoned in favor of synthetic or composite mesh placement. Use of flap reconstruction spread rapidly and the recurrence rate was low. Randomized control trials and a larger sample size are needed to confirm these data and to develop a gold standard treatment for secondary hernia repair after abdominoperineal excision or extralevator abdominoperineal excision.
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Affiliation(s)
- A Balla
- General and Digestive Surgery Unit, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Carrer Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain. .,Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza, University of Rome, Rome, Italy.
| | - G Batista Rodríguez
- General and Digestive Surgery Unit, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Carrer Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain.,Surgical Oncology Unit, Department of Hemato-Oncology, Dr. Rafael A. Calderón Guardia Hospitall, San José, Costa Rica
| | - N Buonomo
- General and Digestive Surgery Unit, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Carrer Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain.,Division of Surgical Physiopathology, Department of General and Digestive Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - C Martinez
- General and Digestive Surgery Unit, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Carrer Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain
| | - P Hernández
- General and Digestive Surgery Unit, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Carrer Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain
| | - J Bollo
- General and Digestive Surgery Unit, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Carrer Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain
| | - E M Targarona
- General and Digestive Surgery Unit, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Carrer Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain
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21
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Papadakis M, Hübner G, Bednarek M, Arafkas M. Composite mesh and gluteal fasciocutaneous rotation flap for perineal hernia repair after abdominoperineal resection: a novel technique. Updates Surg 2017; 69:109-111. [PMID: 28266001 DOI: 10.1007/s13304-017-0427-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 02/21/2017] [Indexed: 10/20/2022]
Abstract
Perineal hernia is an uncommon complication following abdominoperineal rectum resection. Several surgical procedures have been proposed for perineal hernia repair, including perineal, laparoscopic and abdominal approaches. Repair techniques can be classified into primary suture techniques, mesh placements and repairs with autogenous tissue. We report a 68-year-old man with a perineal hernia, who underwent a pelvic floor reconstruction with a transperineal composite mesh and a gluteal fasciocutaneous rotation flap. We conclude that a combined approach with transperineal mesh reconstruction and gluteal fasciocutaneous flap could be an alternative choice in perineal hernia repair after abdominoperineal resection.
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Affiliation(s)
- Marios Papadakis
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, Helios Klinikum Wuppertal, University Hospital Witten-Herdecke, Heusnerstr. 40, 42283, Wuppertal, Germany.
| | - Gunnar Hübner
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, Helios Klinikum Wuppertal, University Hospital Witten-Herdecke, Heusnerstr. 40, 42283, Wuppertal, Germany
| | - Marzena Bednarek
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, Helios Klinikum Wuppertal, University Hospital Witten-Herdecke, Heusnerstr. 40, 42283, Wuppertal, Germany
| | - Mohamed Arafkas
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, Helios Klinikum Wuppertal, University Hospital Witten-Herdecke, Heusnerstr. 40, 42283, Wuppertal, Germany
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22
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Narang SK, Alam NN, Köckerling F, Daniels IR, Smart NJ. Repair of Perineal Hernia Following Abdominoperineal Excision with Biological Mesh: A Systematic Review. Front Surg 2016; 3:49. [PMID: 27656644 PMCID: PMC5011127 DOI: 10.3389/fsurg.2016.00049] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 08/22/2016] [Indexed: 01/30/2023] Open
Abstract
Introduction Perineal hernia (PerH) following abdominoperineal excision (APE) procedure is a recognized complication. PerH was considered an infrequent complication of APE procedure; however, PerH rates of up to 45% have been reported in recent publications following a laparoscopic APE procedure. Various methods of repair of PerH with the use of synthetic meshes or myocutaneous flap have been described, although there is no general agreement on an optimal strategy. The use of biological meshes for different operations is growing in popularity, and these have been promoted as being superior and safer when compared to synthetic meshes. Although the use of biologics is becoming popular claims of better outcomes are largely unsupported by evidence. The aim of this systematic review is to evaluate the currently available evidence supporting the use of biologic or biosynthetic meshes for the repair of PerH that develop following an APE. Methods A systematic review of all English language literature relevant to repair of PerH following APE with biologic or biosynthetic mesh published between January 1, 2000 and July 31, 2016 was carried out using MEDLINE, EMBASE, and the Cochrane Library of Systematic Reviews for relevant literature. Searches were performed using a combination of Medical Subject Headings (MeSH) terms and text words “PerH,” “APE,” “morbidity,” “biologics,” “biosynthetic,” and “hernia.” Studies in which the use of biological meshes was not reported were excluded from the review. Various outcome measures, including operative technique, complication rates, recurrence rates, type of mesh, management of recurrences, and risk factors, were extracted. Oxford Centre for Evidence-based Medicine – Levels of Evidence (March 2009) was used to assess the quality of evidence. Results The systematic review of the literature identified three case reports, four case series, and one pooled analysis that were included in the final review. Overall, these studies were of poor quality providing level 4 evidence. Various different approaches and techniques of repair of PerH were described; however, it was difficult to extract information with regard to the primary and secondary outcome measures. Conclusion There is no general agreement to the optimal operative strategy to repair PerH following an APE. There is insufficient evidence to recommend any specific operative approach or repair technique for PerH following an APE.
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Affiliation(s)
- Sunil K Narang
- Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon and Exeter Hospital , Exeter, Devon , UK
| | - Nasra N Alam
- Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon and Exeter Hospital , Exeter, Devon , UK
| | - Ferdinand Köckerling
- Department of Surgery, Center for Minimally Invasive Surgery, Vivantes Hospital, Academic Teaching Hospital of Charité Medical School , Berlin , Germany
| | - Ian R Daniels
- Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon and Exeter Hospital , Exeter, Devon , UK
| | - Neil J Smart
- Exeter Surgical Health Services Research Unit (HeSRU), Royal Devon and Exeter Hospital , Exeter, Devon , UK
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