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

Abstract

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.

Further insights into the treatment of perineal hernia based on a the experience of a single tertiary centre

“…A perineal hernia often causes some degree of discomfort or pain, and may more rarely result in urinary complaints, small bowel obstruction or perineal necrosis with evisceration . In symptomatic patients, surgical repair can be offered.…”

Mesh, flap or combined repair of perineal hernia after abdominoperineal resection – A systematic review and meta‐analysis

“…In the current literature the incidence of symptomatic perineal hernia ranges from 7% to 30% [ 1 , 2 , 3 ]. A perineal hernia may cause discomfort, pain, wound healing problems, urogenital dysfunction and small bowel obstruction [ 4 , 5 , 6 ]. Depending on the severity of symptoms, preference and experience of the surgeon, an elective repair is sometimes considered.…”