Two case reports of perineal hernia after laparoscopic abdominoperineal resection with a proposed modification to the operative technique

Abstract

Perineal hernia is a rare complication following laparoscopic abdominoperineal resection (APR) for rectal cancer. We present two case reports of perineal hernia following laparoscopic APR and discuss their management. We suggest that they developed because the pelvic peritoneum was left open during laparoscopic APR and propose that closure of the pelvic peritoneum should be routine in this operation.

Traumatic small bowel perforation in a case of a perineal hernia

“…It is our suggestion that surgical practice should be modified with a view to prevention of this problem by reconstruction of the pelvic peritoneum after laparoscopic APR as is already being practiced during an open procedure. This has also been proposed by other colleagues [ 4 ].…”

“…These are secondary perineal hernias. We now know risk factors include pre-operative radiotherapy, female gender and postoperative perineal wound infection [ 4 ].…”

“…a senior surgeon with 20 years’ experience performing open APR with routine reconstruction of pelvic peritoneum describes no development of perineal hernia. However, since adoption of laparoscopic approach over 4 years there have been 2 out of 12 cases [ 4 ]. This would require further randomized controlled studies to prove, however, this would require a change in surgical practice.…”