Incidence and Management of Perineal Hernia After Laparoscopic Proctectomy

Abstract

Perineal hernia (PH) is formed by the protrusion of intra-abdominal viscera through a defect in the pelvic floor. This is a rare complication after conventional abdominoperineal resection, pelvic exanteration, proctectomy, and other pelvic procedures. The purpose of the present paper is to report 4 cases of PH after laparoscopic abdominoperineal resection for rectal cancer and to review literature data about the incidence, predisposing factors, and treatment of this challenging problem. When added to other 3 cases previously reported in the Brazilian series of laparoscopic surgery, this group of 7 cases comprises a PH incidence of 3.5% after rectal resection procedures. Surgical treatment is indicated only in symptomatic patients with no signs of cancer recurrence. Proposed methods of surgical repair include abdominal, perineal, or combined approaches to the hernia in association with the use of autologous tissues or prosthetic meshes. Preventive measures are represented by closure of the pelvic peritoneum whenever possible, primary perineal suture and wound care to avoid infection.

Perineal Hernia Repair After Abdominoperineal Rectal Excision

“…As shown in Table 2, most articles were case reports, 13-23 and 5 reviews were identified. 2,4,7,8,24 The 4 largest series described the results of n ϭ 8, n ϭ 8, n ϭ 9, and n ϭ 21 patients. 1,2,4,8 Most studies were small and were performed before mesh-based techniques were used.…”

Mesh-Based Transperineal Repair of a Perineal Hernia After a Laparoscopic Abdominoperineal Resection

“…Different anatomic, technical, and clinical factors, including the larger size of the female pelvis, a previous hysterectomy, radiotherapy, coccygectomy, excessive length of small bowel mesentery, and perineal infection, may facilitate the formation of a PH after an APR [3]. Perineal wound complications, such as impaired perineal healing and infection, especially secondary to radiotherapy, seem to have an important etiological role [4].…”

Éventrations périnéales après exérèse rectale ou pelvienne. Prise en charge actuelle et prévention

“…Toutes interventions confondues, en 2006, Aboian et al retrouvaient une incidence de 0,2 % sur un total de 3 761 patients, chiffre un peu moins élevé que celui retrouvé par So et al, en 1997, qui rapportaient une incidence de 0,62 % sur une série de 1 776 AAP [1,2]. Très récemment, de Campos et al ont rapporté de façon intéressante une incidence plus élevée (3,5 %) d'EP après proctectomie laparoscopique dans une série multicentrique brésilienne, information qui méritera d'être confirmée sur de plus grandes séries [3]. L'incidence des EP s'accroît avec l'importance de l'exérèse pelvienne.…”

“…L'incidence des EP s'accroît avec l'importance de l'exérèse pelvienne. Le risque s'élève ainsi à plus de 3 % dans les pelvectomies [1,3]. Mais il faut bien noter que cette incidence est très certainement sous-estimée, les EP symptomatiques et/ou cliniquement évidentes étant seules rapportées en l'absence de recherche systématique de l'anomalie anatomique postopératoire.…”