1
|
Olivero AA, Valinoti AC, Murdoch Duncan N, Sadava EE. Recurrent perineal hernia: Laparoscopic approach-A video vignette. Colorectal Dis 2024. [PMID: 39072980 DOI: 10.1111/codi.17111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 05/24/2024] [Accepted: 06/08/2024] [Indexed: 07/30/2024]
Affiliation(s)
- Ayelen A Olivero
- Department of Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina
| | - Agustin C Valinoti
- Department of Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina
- Division of Abdominal Wall Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina
| | | | - Emmanuel E Sadava
- Department of Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina
- Division of Abdominal Wall Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina
| |
Collapse
|
2
|
Prandzhev GD, Feradova HE, Tzankov DT, Gortchev GA, Totev TP. Anterior perineal hernia - A case report of a rare complication after pelvic exenteration. Int J Surg Case Rep 2024; 120:109859. [PMID: 38875825 PMCID: PMC11225180 DOI: 10.1016/j.ijscr.2024.109859] [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: 03/25/2024] [Revised: 05/30/2024] [Accepted: 06/01/2024] [Indexed: 06/16/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Perineal hernias are protrusions of intra-abdominal contents resulting from weakness of the pelvic floor muscles. They are an uncommon complication after ultraradical pelvic surgeries, with no established gold standard for surgical treatment. This case describes a rare anterior perineal hernia that developed after radical surgery for bladder carcinoma. CASE PRESENTATION A 77-year-old Caucasian woman presented with a painful 10 cm bulge in the perineal region. The hernial sac involved the entire left labia majora and developed 4 years after radical surgery for bladder carcinoma. She had been misdiagnosed twice in the past with vaginal prolapse, leading to two unsuccessful vaginoplasty procedures due to recurrence. She underwent hernia repair with perineal approach and polypropylene mesh placement. The postoperative period was uncomplicated, and the patient was discharged after five days, with histology showing no malignancy. CLINICAL DISCUSSION Perineal hernias are protrusions of intra- or extraperitoneal contents into the perineum due to a defect in the pelvic musculature. Various surgical modalities exist for perineal hernia repair, which adhere to the fundamental principles of hernia surgery: sac mobilization, precise incision, sac debridement and excision, and defect repair. Here, we successfully applied the perineal approach in a complicated case of a misdiagnosed perineal hernia after radical surgery. CONCLUSION The perineal approach for hernia repair, involving an implantation of a polypropylene mesh and tissue flap was successfully applied, confirming its main place in the surgical treatment of perineal hernias. During the two-year follow-up no postoperative complications or recurrence hernia were registered.
Collapse
Affiliation(s)
- Georgi D Prandzhev
- Medical Univeristy - Pleven, Department of Obstetrics and Gynecology, Bulgaria; University Hospital Saint Marina, Pleven, Bulgaria.
| | - Hyuliya E Feradova
- Medical Univeristy - Pleven, Department of Obstetrics and Gynecology, Bulgaria; University Hospital Saint Marina, Pleven, Bulgaria
| | - Dimitar T Tzankov
- Medical Univeristy - Pleven, Department of Obstetrics and Gynecology, Bulgaria; University Hospital Saint Marina, Pleven, Bulgaria
| | - Grigor A Gortchev
- Medical Univeristy - Pleven, Department of Obstetrics and Gynecology, Bulgaria; University Hospital Saint Marina, Pleven, Bulgaria
| | - Tihomir P Totev
- Medical Univeristy - Pleven, Department of Obstetrics and Gynecology, Bulgaria; University Hospital Saint Marina, Pleven, Bulgaria
| |
Collapse
|
3
|
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: 0] [Impact Index Per Article: 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.
Collapse
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
| |
Collapse
|
4
|
Moiș E, Graur F, Horvath L, Furcea L, Zaharie F, Vălean D, Moldovan S, Al Hajjar N. Perineal Hernia Mesh Repair Using Only the Perineal Approach: How We Do It. J Pers Med 2023; 13:1456. [PMID: 37888067 PMCID: PMC10608043 DOI: 10.3390/jpm13101456] [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: 09/07/2023] [Revised: 09/21/2023] [Accepted: 09/26/2023] [Indexed: 10/28/2023] Open
Abstract
Perineal hernia is a rare complication of rectal surgery. Different types of surgical approach have been described, but none of them have proven their superiority. Although there are many methods of closing the defect, we selected two cases to present from a series of five cases, in which the perineal hernia was successfully resolved surgically using only the perineal approach. The reconstruction of the perineal floor and closure of the defect were performed using a synthetic polypropylene mesh. The significance of this Technical Note article lies in the fact that we describe, step by step, a surgical technique for perineal hernia using just a perineal approach.
Collapse
Affiliation(s)
- Emil Moiș
- 3rd Department of Surgery, University of Medicine and Pharmacy “Iuliu Hațieganu”, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania; (E.M.); (L.H.); (L.F.); (F.Z.); (D.V.); (S.M.); (N.A.H.)
- Regional Institute of Gastroenterology and Hepatology “O. Fodor”, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania
| | - Florin Graur
- 3rd Department of Surgery, University of Medicine and Pharmacy “Iuliu Hațieganu”, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania; (E.M.); (L.H.); (L.F.); (F.Z.); (D.V.); (S.M.); (N.A.H.)
- Regional Institute of Gastroenterology and Hepatology “O. Fodor”, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania
| | - Levente Horvath
- 3rd Department of Surgery, University of Medicine and Pharmacy “Iuliu Hațieganu”, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania; (E.M.); (L.H.); (L.F.); (F.Z.); (D.V.); (S.M.); (N.A.H.)
- Regional Institute of Gastroenterology and Hepatology “O. Fodor”, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania
| | - Luminița Furcea
- 3rd Department of Surgery, University of Medicine and Pharmacy “Iuliu Hațieganu”, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania; (E.M.); (L.H.); (L.F.); (F.Z.); (D.V.); (S.M.); (N.A.H.)
- Regional Institute of Gastroenterology and Hepatology “O. Fodor”, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania
| | - Florin Zaharie
- 3rd Department of Surgery, University of Medicine and Pharmacy “Iuliu Hațieganu”, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania; (E.M.); (L.H.); (L.F.); (F.Z.); (D.V.); (S.M.); (N.A.H.)
- Regional Institute of Gastroenterology and Hepatology “O. Fodor”, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania
| | - Dan Vălean
- 3rd Department of Surgery, University of Medicine and Pharmacy “Iuliu Hațieganu”, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania; (E.M.); (L.H.); (L.F.); (F.Z.); (D.V.); (S.M.); (N.A.H.)
- Regional Institute of Gastroenterology and Hepatology “O. Fodor”, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania
| | - Septimiu Moldovan
- 3rd Department of Surgery, University of Medicine and Pharmacy “Iuliu Hațieganu”, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania; (E.M.); (L.H.); (L.F.); (F.Z.); (D.V.); (S.M.); (N.A.H.)
- Regional Institute of Gastroenterology and Hepatology “O. Fodor”, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania
| | - Nadim Al Hajjar
- 3rd Department of Surgery, University of Medicine and Pharmacy “Iuliu Hațieganu”, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania; (E.M.); (L.H.); (L.F.); (F.Z.); (D.V.); (S.M.); (N.A.H.)
- Regional Institute of Gastroenterology and Hepatology “O. Fodor”, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania
| |
Collapse
|
5
|
Al-Diery M, Arachchi A, Lekamalage BBW, Patel PS, Moot AR. How to do it: perineal hernia repair. ANZ J Surg 2023. [PMID: 37128801 DOI: 10.1111/ans.18487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/12/2023] [Indexed: 05/03/2023]
Abstract
Perineal hernias are rare complications of surgeries like abdominoperineal resections. This submission is an educational piece outlining the steps to completing a posterior perineal hernia repair with mesh.
Collapse
Affiliation(s)
- Mohammad Al-Diery
- Department of General Surgery, North Shore Hospital, Auckland, New Zealand
| | - Asiri Arachchi
- Department of General Surgery, North Shore Hospital, Auckland, New Zealand
| | | | | | - Andrew Robert Moot
- Department of General Surgery, North Shore Hospital, Auckland, New Zealand
| |
Collapse
|
6
|
Watanaskul S, Schwab ME, Colley A, Chern H, Varma MG, Hoffman WY, Sarin A. Robotic repair of perineal hernias: a video vignette and review of the literature. Surg Endosc 2023; 37:2290-2294. [PMID: 35982283 PMCID: PMC10017789 DOI: 10.1007/s00464-022-09521-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 07/26/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Perineal hernias can be secondarily acquired following abdominoperineal resection of the rectum. While transabdominal minimally invasive techniques have traditionally used laparoscopy, there are few studies published on the robotic platform, which has been gaining popularity for other types of hernia repairs. We review the existing literature, share a video vignette, and provide practical tips for surgeons interested in adopting this approach. METHODS A literature search in Pubmed was performed to include all articles in English describing robotic repair of perineal hernias with identification of variables of interest related to repair. A case presentation with an accompanying video vignette and lessons learned from the experience are provided. RESULTS Seven case reports (four containing video) published between 2019 and 2022 were included. Most articles (n = 5) utilized the Da Vinci Si or Xi, and most patients (n = 5) had undergone abdominoperineal resection with neoadjuvant chemotherapy to treat rectal cancer. Patients were positioned in Trendelenburg with rightward tilt (n = 2), modified lithotomy (n = 1), or a combination of the two (n = 1). All articles (n = 7) reported closing the defect and using mesh. Three articles describe placing five ports (one camera, three robotic, one assistant). There were no significant intraoperative or postoperative complications reported, and no recurrence noted at 3-27 months follow-up. Based on our experience, as shown in the video vignette, we recommend lithotomy positioning, using porous polypropylene mesh anchored to the periosteum of the sacrum and peritoneum overlying the bladder and side wall, and placing a drain above the mesh. CONCLUSIONS A robotic transabdominal approach to perineal hernia repair is a viable alternate to laparoscopy based on low complication rates and lack of recurrence. Prospective and longer duration data are needed to compare the techniques.
Collapse
Affiliation(s)
- Sarah Watanaskul
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Marisa E Schwab
- Department of Surgery, University of California San Francisco, 550 16th Street, San Francisco, CA, 94143, USA.
| | - Alexis Colley
- Department of Surgery, University of California San Francisco, 550 16th Street, San Francisco, CA, 94143, USA
| | - Hueylan Chern
- Department of Surgery, University of California San Francisco, 550 16th Street, San Francisco, CA, 94143, USA
| | - Madhulika G Varma
- Department of Surgery, University of California San Francisco, 550 16th Street, San Francisco, CA, 94143, USA
| | - William Y Hoffman
- Department of Plastic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Ankit Sarin
- Department of Surgery, University of California San Francisco, 550 16th Street, San Francisco, CA, 94143, USA
| |
Collapse
|
7
|
Maspero M, Heilman J, Otero Piñeiro A, Steele SR, Hull TL. Techniques of perineal hernia repair: A systematic review and meta-analysis. Surgery 2023; 173:312-321. [PMID: 36404179 DOI: 10.1016/j.surg.2022.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Perineal hernias are rare, underreported and poorly studied complications of extensive pelvic surgeries. Their management is challenging, with currently no treatment algorithm available. METHOD MEDLINE, EMBASE, Cochrane Library, and Web of Science databases were searched. Studies comprising at least 3 patients who underwent surgical perineal hernia repair were included. The primary outcome was perineal hernia recurrence. The secondary outcomes were overall complications and surgical site occurrences. RESULTS Twenty-nine studies were included, comprising 325 patients undergoing 347 repairs. Overall complications were 33% (95% confidence interval 24%-43%) in the entire cohort, 31% (19%-44%) after perineal repair, 39% (14%-67%) after abdominal repair, and 36% (19%-53%) after mesh repair (20% with biological, 46% with synthetic mesh). The surgical site occurrence rate was 18% (8%-29%). The overall recurrence rate was 22% (15%-29%). Recurrence after perineal repair was 19% (10%-29%): 20% with mesh (25% with biological, 19% with synthetic), 24% with primary repair, and 39% with flap repair. Recurrence after an abdominal repair was 18% (11%-26%): 16% with laparoscopic, 12% with open, 16% with mesh (24% with biological, 16% with synthetic), 30% with primary, and 25% with flap repair. No significant differences could be found in the meta-analysis regarding overall complications and recurrence. CONCLUSION Synthetic mesh repair seems to be associated with a lower recurrence rate than other techniques, especially after an abdominal approach. The perineal and abdominal approaches appear to be safe, with similar recurrence rates. The combined approach seems promising, but more evidence is needed.
Collapse
Affiliation(s)
- Marianna Maspero
- Department of Colon and Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, OH. http://www.twitter.com/MariannaMaspero
| | - Jaclyn Heilman
- General Surgery, Jefferson Health-Abington, Abington, PA
| | - Ana Otero Piñeiro
- Department of Colon and Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, OH. http://www.twitter.com/AnaOtero_MD
| | - Scott R Steele
- Department of Colon and Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, OH. http://www.twitter.com/ScottRSteeleMD
| | - Tracy L Hull
- Department of Colon and Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, OH.
| |
Collapse
|
8
|
Perineal hernia repair after abdominoperineal resection (APR) with the laparoscopic-peritoneal dual fixation technique. Hernia 2022; 26:1307-1314. [PMID: 35652965 DOI: 10.1007/s10029-022-02632-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/08/2022] [Indexed: 01/14/2023]
Abstract
PURPOSE Perineal hernia (PH) following abdominoperineal resection (APR) is a rare but challenging problem. Although different techniques have been described in literature, the recurrence rate is still remarkable, and there is no consensus regarding the optimal repair approach. In the present study, we reported our experience based on a consecutive series of ten cases. METHODS Ten symptomatic large perineal hernias were repaired exclusively with the same laparoscopic-perineal dual fixation technique. Key steps consist laparoscopic adhesiolysis, hernia contents reduction, open excess perineal hernia sac resection, and mesh placement and dual fixation. Frist, a coated mesh was fixed to the sacrum and pelvic sidewalls with the metallic tacks in the laparoscopic step, second, the mesh was fixed anteriorly to urogenital diaphragm and laterally to the sacrotuberous ligament with permanent sutures in the perineal step. RESULTS Ten symptomatic PHs were repaired by the same laparoscopic-perineal dual fixation technique, 6 males and 4 females, median age at the time of repair was 69.5 years (range 66-77 years), the BMI was 24 ± 1. Four concomitant procedures were performed, including bilateral inguinal hernia repair with the transabdominal preperitoneal repair (TAPP) in one case, and laparoscopic parastomal hernia repair in two patients. The average operative time was 171 ± 45 min; the postoperative average hospital stay was 14 ± 4 days. There was no perineal hernia recurrence during the follow-up period (the median follow-up was 42 months; range 1-63 months). CONCLUSION Perineal hernia after APR is a rare and challenging postoperative complication, although many different approaches have been described, the recurrence is still high and the best method cannot be drawn. The present laparoscopic-perineal dual fixation approach proved to be a reproducible, effective and durable technique, and gave excellent results during the medium-long-term follow-up.
Collapse
|
9
|
Abstract
BACKGROUND 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. OBJECTIVE 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. DESIGN This study was a retrospective case series. SETTINGS This study was conducted in a large, single institution setting. PATIENTS Patients who underwent surgical repair for perineal hernia from January 2009 to December 2019 were included. MAIN OUTCOME MEASURES The primary outcomes were perineal hernia recurrence, surgical approach to repair, and length of stay. RESULTS 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. LIMITATIONS 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. CONCLUSIONS 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. REPARACIN QUIRRGICA DE HERNIA PERINEAL POSOPERATORIA UN CASO PARA EL ABORDAJE PERINEAL 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).
Collapse
|
10
|
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.
Collapse
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
| |
Collapse
|
11
|
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.
Collapse
|
12
|
Minimally Invasive Repair of a Posterior Perineal Hernia With Mesh: A Case Report. Female Pelvic Med Reconstr Surg 2021; 27:e691-e695. [PMID: 34690261 DOI: 10.1097/spv.0000000000001106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
13
|
Glanzer R, O'Neil B, Turaihi H. Pararectal hernia: literature review and surgical repair techniques in the era of robotic surgery. J Surg Case Rep 2021; 2021:rjab378. [PMID: 34476082 PMCID: PMC8407028 DOI: 10.1093/jscr/rjab378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 08/04/2021] [Indexed: 11/15/2022] Open
Abstract
A pelvic hernia is the protrusion of intraperitoneal or extraperitoneal contents into the perineum through a defect in the pelvic floor. Pelvic hernias are rare with no gold standard method for repair. After abdominoperineal resection, a commonly cited incidence of perineal hernia is 1%. Here, we describe a robotic repair of a pararectal hernia in a post-menopausal women presenting with rectal herniation through a pelvic floor defect causing issues with fecal urgency and incontinence.
Collapse
Affiliation(s)
| | - Breanna O'Neil
- Department of General Surgery, Sanford School of Medicine, Sioux Falls, SD, USA
| | - Hassan Turaihi
- Department of General Surgery, Sanford Health, Sioux Falls, SD, USA
| |
Collapse
|
14
|
Dahan M, Krief D, Pouget N, Rouzier R. Laparoscopic perineal hernia repair following pelvic exenteration: a case report. BMC Surg 2021; 21:245. [PMID: 34006269 PMCID: PMC8132409 DOI: 10.1186/s12893-021-01237-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 05/03/2021] [Indexed: 11/10/2022] Open
Abstract
Background Acquired perineal hernia is a rare complication following extensive pelvic surgery. Radiotherapy is also a predisposing factor. Perineal hernia can cause chronic perineal pain, bowel obstruction, urinary disorders and a cosmetically disfiguring defect. The treatment of perineal hernia is surgical, usually consisting of mesh repair via an abdominal or perineal approach. Case presentation We present a case report and a surgical video of a 42-year-old woman with history of a squamous cell carcinoma. This patient had 3 recurrences since the diagnosis and a symptomatic perineal hernia. Complete regression of the recurrent malignancy allowed us to treat the perineal hernia. We performed laparoscopic repair with prosthetic mesh in this patient who had undergone multiple surgeries and radiotherapy, while preserving the omental flap that was used to reconstruct the posterior part of the vagina. Conclusion There is no consensus concerning the preferred surgical approach, perineal or laparoscopic, as no study has demonstrated the superiority of either of these approaches. Laparoscopic repair for an acquired perineal hernia is safe and feasible. However, further studies including randomized trials are required to precisely evaluate the best surgical approach and type of mesh. Supplementary Information The online version contains supplementary material available at 10.1186/s12893-021-01237-9.
Collapse
Affiliation(s)
- Méryl Dahan
- Département d'oncologie Chirurgicale, Institut Curie, PSL Research University, 35, Rue Dailly, 92210, Saint-Cloud, France. .,Inserm U900, Cancer et génome : bioinformatique, biostatistiques et épidémiologie, Institut Curie, Saint Cloud, France.
| | - David Krief
- Département d'oncologie Chirurgicale, Institut Curie, PSL Research University, 35, Rue Dailly, 92210, Saint-Cloud, France
| | - Nicolas Pouget
- Département d'oncologie Chirurgicale, Institut Curie, PSL Research University, 35, Rue Dailly, 92210, Saint-Cloud, France
| | - Roman Rouzier
- Département d'oncologie Chirurgicale, Institut Curie, PSL Research University, 35, Rue Dailly, 92210, Saint-Cloud, France.,Inserm U900, Cancer et génome : bioinformatique, biostatistiques et épidémiologie, Institut Curie, Saint Cloud, France.,Université Paris-Saclay, 78180, Montigny-le-Bretonneux, France
| |
Collapse
|