Prevention of perineal hernia after laparoscopic and robotic abdominoperineal resection: review with illustrative case series of internal hernia through pelvic mesh

Melich, George; Lim, Dong-Jin; Hur, Hyuk; Min, Byung Soh; Baik, Seung Hyuk; Arena, Goffredo; Gordon, Philip H.; Kim, Nam Kyu

doi:10.1503/cjs.003115

Cited by 17 publications

(14 citation statements)

References 15 publications

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“…NPWT for the pelvic cavity carries a risk of abdominal organ injury. Therefore, it is important to provide sufficient separation from internal organs to perform safe NPWT [ 13 ].According to past reports, pelvic floor reconstruction using skin flap and mesh implantation is effective for separating the abdominal and pelvic cavities [ [14] , [15] , [16] , [17] , [18] ]. In our method, these reconstruction techniques are unnecessary due to the suturing of the levator ani muscle.…”

Section: Discussionmentioning

confidence: 99%

Case series of in situ pelvic floor reconstruction combining levator ani suture and negative pressure wound therapy for abdominoperineal resection

Ito

Yoshida

Ohdaira

et al. 2019

Annals of Medicine and Surgery

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Background Abdominoperineal resection (APR) is a standard surgical technique for low rectum cancer with a low recurrence rate. There are some problems associated with APR such as perineal hernia and perineal surgical site infection. Recently, the prophylactic efficacy of negative pressure wound therapy (NPWT) for surgical site infection has been reported. Herein, we analyzed the efficacy of in situ pelvic floor reconstruction combining levator ani suture and NPWT after APR for perineal hernia and perineal surgical site infection. Methods We analyzed six patients treated by laparoscopic APR with NPWT combined with levator ani suture retrospectively. The primary endpoints were surgical site infection within 30 days and perineal hernia within 1 year after surgery. The day following surgery, we performed NPWT for the perineal wound using the VAC ® abdominal wound management system (KCI, San Antonio, TX, USA). Results There were four male and two female patients ranging in age from 69 to 86 years (mean: 76 years). The mean NPTW duration was 17 days (13–20 days). The length of the postoperative hospital stay was 14–22 days (median: 18 days). There was no patient with surgical site infection within 30 days or with perineal hernia within 1 year after surgery. Conclusion We experienced the in situ pelvic floor reconstruction combining levator ani suture and NPWT after laparoscopic APR for perineal hernia and perineal surgical site infection. This combination treatment was safe and may be effective for preventing surgical site infection and perineal hernia.

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Section: Discussionmentioning

confidence: 99%

Case series of in situ pelvic floor reconstruction combining levator ani suture and negative pressure wound therapy for abdominoperineal resection

Ito

Yoshida

Ohdaira

et al. 2019

Annals of Medicine and Surgery

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“…Perineal hernias after APR have a reported prevalence of 7% ; perineal hernias requiring surgical intervention have a reported prevalence of 0.2–0.6% ; and perineal hernias after pelvic exenteration have a reported incidence of about 3% . The reported duration between surgery and hernia formation is usually 4–14 months . Perineal hernia after laparoscopic APR was reported for the first time in 2007 , and some case reports of perineal hernia after APR have recently been published.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic repair of a large perineal hernia after laparoscopic abdominoperineal resection: A case report

Kakiuchi

Saito

Mitsui

et al. 2018

Asian J Endoscop Surgery

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A 75-year-old woman underwent laparoscopic abdominoperineal resection. Four months after abdominoperineal resection, the patient complained of a perineal bulge and urination disorder. Abdominal CT showed protrusion of the small intestine and bladder to the perineum. The patient underwent laparoscopic hernia repair with mesh. The size of the hernial orifice was 7.0 × 9.0 cm, and it had no solid rim. The mesh was tacked ventrally to the pectineal ligament and dorsally to the sacrum, and then sutured on the lateral side. The hernia has not recurred 10 months after the operation. Laparoscopic repair is a good treatment choice for secondary perineal hernia and fixing the mesh to the pectineal ligament, and the sacrum prevents the mesh from sagging.

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“…Neoadjuvant radiotherapy and wound complications after wide resections have a 59% risk of causing perineal hernia [3,4,14]. The postoperative PerH develops between within a year following surgery [17,18].…”

Section: Introductionmentioning

confidence: 99%

Review of Postoperative Perineal Hernia and Available Reconstruction Techniques

Kazuma¹,

Kazi²,

Sukumar³

et al. 2021

SCR

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

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Prevention of perineal hernia after laparoscopic and robotic abdominoperineal resection: review with illustrative case series of internal hernia through pelvic mesh

Cited by 17 publications

References 15 publications

Case series of in situ pelvic floor reconstruction combining levator ani suture and negative pressure wound therapy for abdominoperineal resection

Case series of in situ pelvic floor reconstruction combining levator ani suture and negative pressure wound therapy for abdominoperineal resection

Laparoscopic repair of a large perineal hernia after laparoscopic abdominoperineal resection: A case report

Review of Postoperative Perineal Hernia and Available Reconstruction Techniques

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