Transperineal repair of a perineal hernia with synthetic mesh after a laparoscopic abdominoperineal resection_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 HE Liang , WANG Jiang , LI Ao , ZHANG Yongjiu

Department of General Surgery, Xinjiang Military District Hospital, Urumqi 830000, P. R. China;

Corresponding author：

HE Liang, Email: heliangfmmu@sina.com

Keywords：

perineal hernia; laparoscopic abdominoperineal resection; synthetic mesh

DOI：

10.7507/1007-9424.201807053

Video：

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Objective To summarize the surgical experience of perineal hernia (PH) repairment after a laparoscopic abdominoperineal resection (APR) with synthetic mesh.Methods The clinical data of 4 cases of PH after APR from 2009 to 2015 underwent surgery were analyzed retrospectively. We applied synthetic mesh for the reconstruction of the pelvic floor.Results All of the 4 cases recovered smoothly, with no complication happened. The blood loss during the operation was 50–100 mL, the operative time was 1.0–1.5 hours, the postoperative time of getting out of bed was delayed to 5–7 days after the operation and discharged after 10–14 days. Patients were advised to use transperineal bandages or rigid underpants to lift up the perineum to reduce tension after discharge. No recurrence of perineal hernia or the tumor was found on physical examination and abdominal pelvic CT scan during the 24-month follow-up.Conclusions It brings better effect and less trauma after the operation by using transperineal repair of PH with synthetic mesh. We suggest that this technique should probably be the first choice for treating an uncomplicated PH that occurs after a laparoscopic APR.

Citation： HE Liang, WANG Jiang, LI Ao, ZHANG Yongjiu. Transperineal repair of a perineal hernia with synthetic mesh after a laparoscopic abdominoperineal resection. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(12): 1425-1428. doi: 10.7507/1007-9424.201807053 Copy

1.	Aboian E, Winter DC, Metcalf DR, et al. Perineal hernia after proctectomy: prevalence, risks, and management. Dis Colon Rectum, 2006, 49(10): 1564-1568.
2.	Berthoux L, Labib A, Clough KB, et al. Perineal hernia after abdominoperineal amputation. Role of epiploplasty and/or irradiation. J Chir (Paris), 1992, 129(12): 550-552.
3.	de Campos FG, Habr-Gama A, Araújo SE, et al. Incidence and management of perineal hernia after laparoscopic proctectomy. Surg Laparosc Endosc Percutan Tech, 2005, 15(6): 366-370.
4.	Mjoli M, Sloothaak DA, Buskens CJ, et al. Perineal hernia repair after abdominoperineal resection: a pooled analysis. Colorectal Dis, 2012, 14(7): e400-e406.
5.	Stelzner S, Koehler C, Stelzer J, et al. Extended abdominoperineal excision vs. standard abdominoperineal excision in rectal cancer-a systematic overview. Int J Colorectal Dis, 2011, 26(10): 1227-1240.
6.	Lee TG, Lee SJ. Mesh-based transperineal repair of a perineal hernia after a laparoscopic abdominoperineal resection. Ann Coloproctol, 2014, 30(4): 197-200.
7.	Li J, Zhang W. How we do it: repair of large perineal hernia after abdominoperineal resection. Colorectal Dis, 2012, 27(4): 543-544.
8.	Honjo K, Sakamoto K, Motegi S, et al. Case report of perineal hernia after laparoscopic abdominoperineal resection. Asian J Endosc Surg, 2017, 9(7): 1-4.
9.	Feng B, Lu J, Zhang S, et al. Laparoscopic abdominoperineal excision with trans-abdominal individualized levator transection: interim analysis of a randomized controlled trial. Colorectal Dis, 2017, 19(7): O246-O252.
10.	Papadakis M, Hübner G, Bednarek M, et al. Composite mesh and gluteal fasciocutaneous rotation flap for perineal hernia repair after abdominoperineal resection: a novel technique. Updates Surg, 2017, 69(1): 109-111.
11.	Balla A, Batista Rodríguez G, Buonomo N, et al. Perineal hernia repair after abdominoperineal excision or extralevator abdominoperineal excision: a systematic review of the literature. Tech Coloproctol, 2017, 21(5): 329-336.
12.	Aboian E, Winter DC, Metcalf DR, et al. Perineal hernia after proctectomy: prevalence, risks, and management. Dis Colon Rectum, 2006, 49(10): 1564-1568.
13.	Ryan S, Kavanagh DO, Neary PC. Laparoscopic repair of postoperative perineal hernia. Case Rep Med, 2010, (10): 1155-1158.
14.	Papadakis M, Hübner G, Bednarek M, et al. Composite mesh and gluteal fasciocutaneous rotation flap for perineal hernia repair after abdominoperineal resection: a novel technique. Updates Surg, 2017, 69(1): 109-111.
15.	Abbas Y, Garner J. Laparoscopic and perineal approaches to perineal hernia repair. Tech Coloproctol, 2014, 18(4): 361-364.
16.	Bocková M, Hoch J, Frajer L. Perineal hernia-hernia repair using rectus abdominis muscle flap. Rozhl Chir, 2016, 95(5): 206-209.
17.	Abdul Jabbar AS. Postoperative perineal hernia. Hernia, 2002, 6(4): 188-190.
18.	Arnaud JP, Hennekinne-Mucci S, Pessaux P, et al. Ultrasound detection of visceral adhesion after intraperitoneal ventral hernia treatment: a comparative study of protected versus unprotected meshes. Hernia, 2003, 7(2): 85-88.
19.	Svane M, Bulut O. Perineal hernia after laparoscopic abdomino-perineal resection-reconstruction of the pelvic floor with a biological mesh (PermacolTM). Int J Colorectal Dis, 2012, 27(4): 543-544.
20.	Alam NN, Narang SK, Köckerling F, et al. Biologic mesh reconstruction of the pelvic floor after extralevator abdominoperineal excision: a systematic review. Front Surg, 2016, 3: 9.
21.	Jensen KK, Rashid L, Pilsgaard B, et al. Pelvic floor reconstruction with a biological mesh after extralevator abdominoperineal excision leads to few perineal hernias and acceptable wound complication rates with minor movement limitations: single-centre experience including clinical examination and interview. Colorectal Dis, 2014, 16(3): 192-197.
22.	Wille-Jørgensen P, Pilsgaard B, Møller P. Reconstruction of the pelvic floor with a biological mesh after abdominoperineal excision for rectal cancer. Int J Colorectal Dis, 2009, 24(3): 323-325.

1. Aboian E, Winter DC, Metcalf DR, et al. Perineal hernia after proctectomy: prevalence, risks, and management. Dis Colon Rectum, 2006, 49(10): 1564-1568.
2. Berthoux L, Labib A, Clough KB, et al. Perineal hernia after abdominoperineal amputation. Role of epiploplasty and/or irradiation. J Chir (Paris), 1992, 129(12): 550-552.
3. de Campos FG, Habr-Gama A, Araújo SE, et al. Incidence and management of perineal hernia after laparoscopic proctectomy. Surg Laparosc Endosc Percutan Tech, 2005, 15(6): 366-370.
4. Mjoli M, Sloothaak DA, Buskens CJ, et al. Perineal hernia repair after abdominoperineal resection: a pooled analysis. Colorectal Dis, 2012, 14(7): e400-e406.
5. Stelzner S, Koehler C, Stelzer J, et al. Extended abdominoperineal excision vs. standard abdominoperineal excision in rectal cancer-a systematic overview. Int J Colorectal Dis, 2011, 26(10): 1227-1240.
6. Lee TG, Lee SJ. Mesh-based transperineal repair of a perineal hernia after a laparoscopic abdominoperineal resection. Ann Coloproctol, 2014, 30(4): 197-200.
7. Li J, Zhang W. How we do it: repair of large perineal hernia after abdominoperineal resection. Colorectal Dis, 2012, 27(4): 543-544.
8. Honjo K, Sakamoto K, Motegi S, et al. Case report of perineal hernia after laparoscopic abdominoperineal resection. Asian J Endosc Surg, 2017, 9(7): 1-4.
9. Feng B, Lu J, Zhang S, et al. Laparoscopic abdominoperineal excision with trans-abdominal individualized levator transection: interim analysis of a randomized controlled trial. Colorectal Dis, 2017, 19(7): O246-O252.
10. Papadakis M, Hübner G, Bednarek M, et al. Composite mesh and gluteal fasciocutaneous rotation flap for perineal hernia repair after abdominoperineal resection: a novel technique. Updates Surg, 2017, 69(1): 109-111.
11. Balla A, Batista Rodríguez G, Buonomo N, et al. Perineal hernia repair after abdominoperineal excision or extralevator abdominoperineal excision: a systematic review of the literature. Tech Coloproctol, 2017, 21(5): 329-336.
12. Aboian E, Winter DC, Metcalf DR, et al. Perineal hernia after proctectomy: prevalence, risks, and management. Dis Colon Rectum, 2006, 49(10): 1564-1568.
13. Ryan S, Kavanagh DO, Neary PC. Laparoscopic repair of postoperative perineal hernia. Case Rep Med, 2010, (10): 1155-1158.
14. Papadakis M, Hübner G, Bednarek M, et al. Composite mesh and gluteal fasciocutaneous rotation flap for perineal hernia repair after abdominoperineal resection: a novel technique. Updates Surg, 2017, 69(1): 109-111.
15. Abbas Y, Garner J. Laparoscopic and perineal approaches to perineal hernia repair. Tech Coloproctol, 2014, 18(4): 361-364.
16. Bocková M, Hoch J, Frajer L. Perineal hernia-hernia repair using rectus abdominis muscle flap. Rozhl Chir, 2016, 95(5): 206-209.
17. Abdul Jabbar AS. Postoperative perineal hernia. Hernia, 2002, 6(4): 188-190.
18. Arnaud JP, Hennekinne-Mucci S, Pessaux P, et al. Ultrasound detection of visceral adhesion after intraperitoneal ventral hernia treatment: a comparative study of protected versus unprotected meshes. Hernia, 2003, 7(2): 85-88.
19. Svane M, Bulut O. Perineal hernia after laparoscopic abdomino-perineal resection-reconstruction of the pelvic floor with a biological mesh (PermacolTM). Int J Colorectal Dis, 2012, 27(4): 543-544.
20. Alam NN, Narang SK, Köckerling F, et al. Biologic mesh reconstruction of the pelvic floor after extralevator abdominoperineal excision: a systematic review. Front Surg, 2016, 3: 9.
21. Jensen KK, Rashid L, Pilsgaard B, et al. Pelvic floor reconstruction with a biological mesh after extralevator abdominoperineal excision leads to few perineal hernias and acceptable wound complication rates with minor movement limitations: single-centre experience including clinical examination and interview. Colorectal Dis, 2014, 16(3): 192-197.
22. Wille-Jørgensen P, Pilsgaard B, Møller P. Reconstruction of the pelvic floor with a biological mesh after abdominoperineal excision for rectal cancer. Int J Colorectal Dis, 2009, 24(3): 323-325.

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Transperineal repair of a perineal hernia with synthetic mesh after a laparoscopic abdominoperineal resection

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