Pararectal hernia: literature review and surgical repair techniques in the era of robotic surgery

Glanzer, Rebecca; O’Neil, Breanna; Turaihi, Hassan

doi:10.1093/jscr/rjab378

Cited by 3 publications

(3 citation statements)

References 7 publications

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“…Literature on cross-sectional imaging of patients with perineal hernia is limited, especially in patients with altered anatomy due to flap advancement surgeries. Previously described presentations on imaging utilized contrast-enhanced CT, which showed protrusion of abdominal contents into the perineum, including 1 study which portrayed CT findings of perineal hernia in a patient with a history of abdominoperineal exenteration and inferior gluteal artery perforator flap surgery [ 7 , 9 ]. Although contrast-enhanced CT can help establish the diagnosis, MRI with enterography may have more clinical utility in pCD patients due to its ability to assess for pCD treatment response and detect concurrent active pCD and fistulas [10] .…”

Section: Discussionmentioning

confidence: 99%

Perineal hernia as a sequela of anal reconstruction surgeries in perianal Crohn's disease

Garuba,

McPhie,

Anolik

et al. 2023

Radiology Case Reports

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Section: Discussionmentioning

confidence: 99%

Perineal hernia as a sequela of anal reconstruction surgeries in perianal Crohn's disease

Garuba,

McPhie,

Anolik

et al. 2023

Radiology Case Reports

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“…The surrounding tissue including some pelvic floor muscles was used for coverage of the orifice, although it sounded palliative without enforcement by the mesh placement. The effectiveness of robotic-assisted pelvic floor hernia surgery has recently been reported (5). The benefits of an intra-abdominal approach include avoidance of organs near the hernia and reliable mesh deployment.…”

mentioning

confidence: 99%

Percutaneous surgical repair for a patient with adult pararectal hernia caused by intractable ascites associated with liver cirrhosis

Miyagi

Nakahara

Ohya

et al. 2022

DD&T

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Liver cirrhosis, pararectal hernia, repair of hernia Patients with liver cirrhosis are at increased risk of various visceral hernia because of persistent ascites and tissue fragility. Here we report successful treatment in a patient with pararectal hernia due to liver cirrhosis by a less invasive approach via para-anal region. The patient was a 73-year-old woman with a history of chronic hepatitis B that had been untreated for at least 20 years. At the age of 68 years, she was referred to our hospital for treatment of persistent ascites and thrombocytopenia due to advanced liver cirrhosis. Neither diuretics nor cell-free and concentrated ascites reinfusion therapy could decrease the ascites. She needed repeated paracentesis. She was referred to the surgical department due to the painful swelling of the left buttock which was diagnosed as the pararectal hernia. The welling was huge enough with the erosion of the covering skin. Surgery was planned in view of concern about the possible rupture of the hernia. Due to the massive ascites with the advanced liver cirrhosis, we were reluctant to do the laparotomic approach, and simple closure of the hernial orifice via direct approach from the cutaneous side was planned and performed. The patient was fortunately discharged seven days after the operation without any complications. One year later, there has been no recurrence of the hernia. Even in cases with massive ascites, direct simple closure of the hernia by percutaneous approach may be one of the options for the treatment of the pararectal hernia in case of urgent situation.

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“…Perineal hernia repair is well suited for the robotic approach given the excellent 3-D visualization, ability to work in a limited space and precise suturing of mesh to close defects. However, only a handful of institutions have published their experience using the robotic platform [5][6][7][8][9][10][11]. In this study, we sought to review the existing literature on robotic repair of perineal hernias, provide a video vignette that illustrates the principles of robotic repair, and provide practical tips for surgeons interested in adopting a robotic approach.…”

mentioning

confidence: 99%

Robotic repair of perineal hernias: a video vignette and review of the literature

et al. 2022

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Background Perineal hernias can be secondarily acquired following abdominoperineal resection of the rectum. While transabdominal minimally invasive techniques have traditionally used laparoscopy, there are few studies published on the robotic platform, which has been gaining popularity for other types of hernia repairs. We review the existing literature, share a video vignette, and provide practical tips for surgeons interested in adopting this approach. Methods A literature search in Pubmed was performed to include all articles in English describing robotic repair of perineal hernias with identification of variables of interest related to repair. A case presentation with an accompanying video vignette and lessons learned from the experience are provided. Results Seven case reports (four containing video) published between 2019 and 2022 were included. Most articles (n = 5) utilized the Da Vinci Si or Xi, and most patients (n = 5) had undergone abdominoperineal resection with neoadjuvant chemotherapy to treat rectal cancer. Patients were positioned in Trendelenburg with rightward tilt (n = 2), modified lithotomy (n = 1), or a combination of the two (n = 1). All articles (n = 7) reported closing the defect and using mesh. Three articles describe placing five ports (one camera, three robotic, one assistant). There were no significant intraoperative or postoperative complications reported, and no recurrence noted at 3–27 months follow-up. Based on our experience, as shown in the video vignette, we recommend lithotomy positioning, using porous polypropylene mesh anchored to the periosteum of the sacrum and peritoneum overlying the bladder and side wall, and placing a drain above the mesh. Conclusions A robotic transabdominal approach to perineal hernia repair is a viable alternate to laparoscopy based on low complication rates and lack of recurrence. Prospective and longer duration data are needed to compare the techniques.

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Pararectal hernia: literature review and surgical repair techniques in the era of robotic surgery

Cited by 3 publications

References 7 publications

Perineal hernia as a sequela of anal reconstruction surgeries in perianal Crohn's disease

Perineal hernia as a sequela of anal reconstruction surgeries in perianal Crohn's disease

Percutaneous surgical repair for a patient with adult pararectal hernia caused by intractable ascites associated with liver cirrhosis

Robotic repair of perineal hernias: a video vignette and review of the literature

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