Perineal hernia after abdominoperineal resection – a systematic review

Abstract

<b>Introduction:</b> Perineal hernia (PH), also termed pelvic floor hernia, is a protrusion of intraabdominal viscera into the perineum through a defect in the pelvic floor. </br></br> <b>Aim:</b> The study was conducted to evaluate the cases of perineal hernia resulting as a complication of abdominoperineal resection (APR) of rectal cancer. </br></br> <b> Material and methods:</b> 30 cases from 24 articles published in reputable peer reviewed journals were evaluated for eight variables including [I] patient age, [II] gender, [III] time since APR, [IV] clinical presentation, [V] approach to repair, [VI] type of repair, [VII] presence/absence of pelvic adhesions [VIII] complications. </br></br> <b>Results:</b> There was a total of 30 cases (18 males and 12 females) with a mean age of 71.5 years. The time of onset of symptoms ranged from 6 days to 12 years. Perineal lump with pain was the chief presenting feature followed by intestinal obstruction. Different approaches were adopted to repair by various methods. </br></br> <b>Conclusions:</b> Perineal hernia as a complication of abdominoperineal resection is reported increasingly nowadays, as the approach to management of rectal cancer has gradually got shifted from open to minimally invasive in recent years. There is a need to spread awareness about this condition, so that it is actively looked for, during the postoperative follow-up. Management is surgical repair; the approach and type of repair should be individualized.

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

“…Structural characteristics and changes that influence the width of the pelvic floor defect are relevant risk factors. Incidence appears to be higher in patients with a history of abdominopelvic surgeries such as hysterectomy, proctectomy, and coccygectomy [ 5 , 6 ]. Additional risk factors include smoking, having a larger pelvis, abnormally long small intestinal mesentery, radiotherapy, postoperative pelvic wound complications, and abdominopelvic resection if a minimally invasive approach was utilized [ 7 , 8 ].…”

“…The patient in the current case is a former smoker who underwent multiple pelvic surgeries for his pCD which may have contributed to his risk of developing a perineal hernia. Perineal hernias may present with a perineal lump with or without discomfort, perineal pain, urinary problems, bowel obstruction, and abdominal pain, some of which can also be seen in patients with symptomatic pCD [6] . It is reasonable to suspect that the patient's clinical presentation may be partially attributable to his underlying pCD which is why maximizing pCD management was essential for this case prior to further workup.…”