Vertical Rectus Muscle Flap Repair for Perineal Defect: Abdominoperineal Resection and Perineal Hernia

Takano, Shota; Newman, Martin; Gill, Kiranjeet; Wexner, Steven D.

doi:10.1016/j.jamcollsurg.2015.02.034

Cited by 3 publications

(1 citation statement)

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“…Various surgical techniques (e.g., primary closure, synthetic or composite mesh placement, and flap reconstruction) have been described as surgical options for PH repair [ 7 , 9 , 14 , 16 ]. A recent report documented that mesh placement using nonabsorbable mesh, composite mesh, or biological mesh was performed in approximately 75% of patients, and flap reconstruction with autogenous tissue was used in approximately 25% of patients [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Which Therapeutic Option Is Optimal for Surgery-Related Perineal Hernia After Abdominoperineal Excision in Patients with Advanced Rectal Cancer? A Report of 3 Thought-Provoking Cases

et al. 2018

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Case seriesPatient: Male, 72 • Male, 71 • Male, 76Final Diagnosis: Postoperative perineal herniaSymptoms: Perineal discomfortMedication: —Clinical Procedure: Hernia repairSpecialty: SurgeryObjective:Rare diseaseBackground:Although perineal hernia (PH) is considered a surgery-related complication after abdominoperineal excision, the optimal therapeutic option for PH remains controversial.Case Reports:The first case involved a 72-year-old man in whom PH was diagnosed 6 months after surgery. Laparoscopic findings revealed moderate adhesion at the pelvic floor, and a perineal approach was added. The pelvic floor defect was repaired by composite mesh. Combined laparoscopic surgery with a perineal approach was effective. The second case involved a 71-year-old man in whom PH was diagnosed 7 months after surgery. Laparoscopic findings revealed severe adhesion of the pelvis, and a perineal approach was added. The pelvic floor defect was repaired by composite mesh. The seromuscular layers of the small intestine were injured, and the damaged small intestine was resected and anastomosed. Composite mesh did not cause postoperative infection even with simultaneous bowel resection. The third case involved a 76-year-old man in whom PH was observed 12 years after surgery. Combined laparoscopic surgery with a perineal approach was performed from the beginning of surgery. Laparoscopic findings clearly demonstrated an intractable adhesion. Unexpected injury of the small intestine caused intra-abdominal contamination; therefore, the pelvic floor defect was primarily closed by absorbable sutures. Combined laparoscopic surgery with a perineal approach was effective even in this patient with a huge PH and intractable adhesion.Conclusions:The combination of laparoscopic surgery with a perineal approach is an adequate option for PH treatment, and the perineal approach should be added without hesitation if needed.

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