Synthetic mesh repair of an anterior perineal hernia following robotic radical urethrocystectomy

Abstract

Introduction:Perineal hernia is a protrusion of intra-abdominal viscera through a defect in the pelvic floor and is a rare but challenging complication after extensive abdominoperineal surgery. There have been small series published after colorectal exenteration, but no cases have been reported after radical cystectomy and urethrectomy.Case Presentation:A 68 years old woman developed an anterior perineal hernia, with no vaginal prolapse, after an anterior exenteration for bladder cancer. A perineal approach with the use of a synthetic polypropylene mesh was chosen to resolve the condition. After 6 months of follow-up, the patient has no symptoms or recurrence of the anterior perineal hernia.Conclusion:To our knowledge, this case is the first report of perineal hernia after radical urethrocystectomy. Although being a case report, this article describes a potential and challenging complication after extensive anterior pelvic surgery, that could increase its incidence in the future. Literature review shows that whether perineal, abdominal or combined approach is chosen, surgery must respect hernia repair principles.

Laparoscopic mesh repair of a labial hernia

“…Management of such hernia can be challenging. The use of synthetic mesh for repair of hernia following pelvic exenteration has been described in the literature but that utilised a single synthetic mesh . The use of a synthetic mesh sandwiched in between two biological meshes is a novel approach and the first of its kind to be described.…”

“…The use of synthetic mesh for repair of hernia following pelvic exenteration has been described in the literature but that utilised a single synthetic mesh. 3 The use of a synthetic mesh sandwiched in between two biological meshes is a novel approach and the first of its kind to be described. The surgical logic behind its basis is that the biological meshes either side of the synthetic mesh will re-peritonalise before the meshes absorb, thus the synthetic mesh would not be in direct contact with either the labia or the peritoneal cavity, theoretically reducing the risk of mesh erosion.…”