Laparoscopic repair of postoperative perineal hernia

Abstract

Perineal hernias are rare complications of major pelvic surgeries. Symptomatic hernias should be repaired surgically. The transabdominal laparoscopic approach using synthetic mesh provides an appropriate solution for these hernias.

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

“…12,13 In most cases, the perineal hernias are asymptomatic, but often enough, a dragging feeling and discomfort in the perineum, urinary symptoms and bowel compromise can occur. [2][3][4][5][6] Despite the lack of evidence in the literature, some surgeons feel compelled to reinforce the surgically weakened pelvic floor after APR to prevent these complications. Multiple tissue as well as mesh techniques have been described to reinforce a weakened floor postpelvic surgery.…”

“…The duration between surgery and hernia formation usually reported is 4-14 months. [3][4][5][6] The most common presenting symptoms are perineal pain, dragging sensation and discomfort on standing or sitting. However, to our knowledge, there are no reported early postoperative internal hernias through a mesh defect after laparoscopic or robotic APR related to attempts at perineal hernia prevention.…”

Perineal hernia – different surgical approaches and treatment techniques. A case report

“…In his opinion it has two main advantages: the resorbable hydrophilic film minimizes tissue attachment to the mesh and prevents visceral adhesions, and the non-resorbable polyester provides long-term reinforcement of soft tissues [7]. On the other hand, prosthetic meshes can only be implanted in the absence of pelvic floor infection [6].…”

“…A summary concerning the methods used and outcomes achieved was presented by Dulucq [7]. In four patients the hernia was repaired via the perineal approach and in another four patients via an abdominal incision.…”

“…Dulucq has found that the use of the laparoscopic transabdominal approach offers the advantages of the open transabdominal approach without its limitations [7]). This preserves the pelvic structure from damage and allows for quick recovery.…”