Retrospective analysis of risk factors for postoperative perineal hernia after endoscopic abdominoperineal excision for rectal cancer

Manabe, Tatsuya; Mizuuchi, Yusuke; Tsuru, Yasuhiro; Kitagawa, Hiroshi; Fujimoto, Takaaki; Koga, Yasuo; Nakamura, Masafumi; Noshiro, Hirokazu

doi:10.1186/s12893-022-01538-7

Cited by 4 publications

(3 citation statements)

References 26 publications

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“…Due to the lack of pelvic floor tissue and inaccurate perineal suturing under limited vision, perineal hernias occur in some patients. Other than surgery, risk factors for perineal hernia include neoadjuvant radiotherapy, age, and female sex (9)(10)(11). Typical clinical manifestations of a perineal hernia may include a sensation of fullness in the perineum area, and perineal bulging and pain that may only become noticeable with the Valsalva maneuver.…”

Section: Discussionmentioning

confidence: 99%

Transanal total mesorectal excision port-assisted perineal hernia repair: A case report

Peng

Ge²,

Zhang³

et al. 2022

Front. Oncol.

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Perineal hernia after abdominoperineal resection (APR) is a troublesome problem, and severe cases require surgical treatment. However, perineal hernia repair is challenging, especially when combined with intestinal adhesions. The difficulty of the operation lies in performing adhesiolysis and mesh placement under poor visibility. While there are traditional, laparoscopic and even robotic methods of performing this procedure, no easy and minimally-invasive approach has been reported. Here, we report the case of a patient with perineal hernia, who underwent transanal total mesorectal excision (TaTME) port-assisted laparoscopic perineal hernia repair. The operation was successful, the postoperative recovery was uneventful, the patient’s symptoms improved significantly, and no recurrence was found during the 4-month follow-up. The availability and safety of TaTME port-assisted perineal hernia repair provide a promising approach for hernia repair. Compared with traditional perineal or laparoscopic abdominal approaches, this procedure is less invasive and results in a better field of vision.

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Section: Discussionmentioning

confidence: 99%

Transanal total mesorectal excision port-assisted perineal hernia repair: A case report

Peng

Ge²,

Zhang³

et al. 2022

Front. Oncol.

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“…Risk factors for a perineal hernia include modified approaches like an extralevator abdominoperineal excision (ELAPE), previous perineal surgery, wound infections, perioperative radiotherapy, the female pelvis and excessive small bowel mesentery 3 …”

Section: How To Do Itmentioning

confidence: 99%

“…2 Risk factors for a perineal hernia include modified approaches like an extralevator abdominoperineal excision (ELAPE), previous perineal surgery, wound infections, perioperative radiotherapy, the female pelvis and excessive small bowel mesentery. 3 Due to the rarity of perineal hernias, the literature describing surgical repair is limited. Some of the described methods include both laparoscopic and open repair with utilization of either synthetic or biologic mesh.…”

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confidence: 99%

How to do it: perineal hernia repair

Al‐Diery

Arachchi

Lekamalage

et al. 2023

ANZ Journal of Surgery

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How to do it: perineal hernia repair How to do itA perineal hernia is a protrusion of intra-abdominal contents through a defect in the pelvic floor. This is a very rare complication that can occur following operations such as abdominoperineal resection (APR), proctectomy and pelvic exenteration. The available literature suggests that following an open APR, the prevalence of perineal hernias is 0.34%. 1 Whilst most perineal hernias are asymptomatic, those with symptomatic perineal hernias may describe chronic perineal pain, discomfort and pain with sitting and urinary disorders. They may also present acutely as a bowel obstruction if the hernia contains bowel loops. 2 Risk factors for a perineal hernia include modified approaches like an extralevator abdominoperineal excision (ELAPE), previous perineal surgery, wound infections, perioperative radiotherapy, the female pelvis and excessive small bowel mesentery. 3 Due to the rarity of perineal hernias, the literature describing surgical repair is limited. Some of the described methods include both laparoscopic and open repair with utilization of either synthetic or biologic mesh. 4 In the video (S1), we present the case of a 74-year-old man with a T2N0 low rectal adenocarcinoma that had invaded the upper anal canal. He completed 10 weeks of preoperative neoadjuvant chemoradiotherapy and proceeded for an APR with formation of an end colostomy. Unfortunately, he developed a perineal wound infection requiring a long course of antibiotics and subsequently was found to have a perineal hernia about 9 months after the original surgery. Most perineal hernias present within the first year after an APR. 5 Given the discomfort this was causing him when sitting, he presented for an elective surgical repair of the hernia. His risk factors for a perineal hernia included infection and the neoadjuvant chemoradiotherapy.The video (S1) outlines the necessary steps to perform an elective posterior perineal hernia repair. The patient is first positioned in a modified Kraske ('jack-knife') position which allows for adequate access to the perineal region. 6 A linear incision is made along the length of the skin overlying the hernia. The hernia sac is then identified and with careful dissection, both edges of the sac are teased away from the midline skin incision. The extent of dissection laterally includes the levator ani muscles, proximally as far as the coccyx and as far as possible inferiorly. A small segment of the sac is excised. The levator ani muscles either side of the defect are freed to ensure an approximate area for suture placement. The small bowel and tissue underlying the hernia is then carefully inspected, looking for any enterotomy, serosal tears or adhesions. The peritoneum over the sac is then closed with

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Short- and mid-term outcomes of abdominoperineal resection with perineal mesh insertion: a single-centre experience

Gendia,

Rehman,

Lin

et al. 2023

Int J Colorectal Dis

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Retrospective analysis of risk factors for postoperative perineal hernia after endoscopic abdominoperineal excision for rectal cancer

Cited by 4 publications

References 26 publications

Transanal total mesorectal excision port-assisted perineal hernia repair: A case report

Transanal total mesorectal excision port-assisted perineal hernia repair: A case report

How to do it: perineal hernia repair

Short- and mid-term outcomes of abdominoperineal resection with perineal mesh insertion: a single-centre experience

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