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Perineal Hernia
Published in Jeff Garner, Dominic Slade, Manual of Complex Abdominal Wall Reconstruction, 2020
The term perineal hernia covers a multitude of entities across the literature over time, and historically was used to describe any hernia that presented as a bulge in the perineum; the nomenclature has now been clarified and perineal, pudendal, obturator and sciatic hernia have all been separately defined.1 Primary perineal hernias are extremely uncommon1 but secondary perineal hernias, which are essentially another form of incisional hernia, are seemingly increasing in frequency.2
Abdomino-Perineal Excision for Rectal Cancer
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Perineal hernia is a late complication after removal of the pelvic floor, and it is likely that the rate of this complication increases with a more extensive removal of the pelvic floor. The incidence is variable in different reports but has been as high as 45% after laparoscopic ELAPE and primary closure of the perineum.55
The Appear Procedure
Published in P Ronan O’Connell, Robert D Madoff, Stanley M Goldberg, Michael J Solomon, Norman S Williams, Operative Surgery of the Colon, Rectum and Anus Operative Surgery of the Colon, Rectum and Anus, 2015
Norman S Williams, Khalid A El-Gendy
Perineal herniation is rare following the APPEAR technique provided a levatorplasty is performed routinely, but may manifest as perineal bulging during defecation or symptoms of obstructed defecation and incomplete evacuation. This is best investigated with evacuation proctography that will demonstrate the perineal hernia and usually demonstrate retention of contrast. Should a hernia develop this is best treated with a levatorplasty reinforced with a biological mesh.
Perineal hernia mesh repair: a fixation with glue, sutures and tacks. How to do it
Published in Acta Chirurgica Belgica, 2019
L. Hassan, A. Beunis, M. Ruppert, V. Dhooghe, S. Van den Broeck, G. Hubens, N. Komen
Symptomatic perineal hernia (PH) after abdomino-perineal rectum amputation (APR) is a rare and complex surgical problem, with an incidence smaller than 1% after abdominoperineal resection [1]. This is most likely underestimated since asymptomatic PHs are often not documented. Surgical repair of a PH is warranted in case of associated symptoms, like perineal swelling and pain [2], or when complications of PH occur, consisting of small bowel obstruction or strangulation, skin breakdown and evisceration [3]. The surgical approach to the hernial defect may be challenging due to the confined space of the pelvis, difficulties reducing and controlling the bowel and the problem of adequate fixation of a mesh. The surgical approach can be transperineal or transabdominal, this could be done either open or laparoscopic. Alternatively, a combined abdominoperineal approach can also be considered. Unfortunately, no consensus exists on the approach, however, mesh repair is recommended since it reduces the risk of recurrence in comparison with primary suture. Consequently, the risk of recurrence is largely determined by the fixation of the mesh [4].
Outcomes of perineal wound closure techniques after abdominoperineal resections in rectal cancer: an NSQIP propensity score matched study
Published in Journal of Plastic Surgery and Hand Surgery, 2023
Jose L. Cataneo, Sydney A. Mathis, Diana D. del Valle, Alejandra M. Perez-Tamayo, Anders F. Mellgren, Gerald Gantt, Lee W. T. Alkureishi
The most commonly performed closure technique was PC of all layers. This approach is preferred when treating small perineal defects [12]. Furthermore, patients with T1 and T2 tumors are likely suitable candidates for primary repair, as patients from this group are more likely to have a smaller defect [4,16]. Larger perineal defects benefit from flap closure. Devulapalli et al. have shown that the use of flap reconstruction for complex defects decreases complications by more than 50% [13]. Nevertheless, every prior study utilizing the NSQIP database has shown myocutaneous flaps leading to higher morbidity, particularly, wound dehiscence, where single institution studies have found otherwise [6–11]. Our results are consistent with Devulapalli et al. as patients with advanced stage tumors and larger defects, were most likely to have APR closure with LE and RAM flaps, with no subsequent increase in postoperative complications [13]. Neoadjuvant therapy was not shown to predispose a patient to a particular closure technique following APR. Myocutaneous flaps were also more commonly used in cases with multiorgan resection. The role of biologic mesh closure following conventional APR’s has also been studied [17,18]. A randomized control trial demonstrated similar rates of uncomplicated perineal wound healing at 30 days with a statistically significant lower one-year perineal hernia rate in the biologic mesh group. The five-year follow up demonstrated significantly lower rates of symptomatic perineal hernia in the biologic mesh group without a difference in chronic perineal wound morbidity, locoregional recurrence and overall survival [18].