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Perineal Hernia Repair After Abdominoperineal Rectal Excision

Martijnse, I. S. M.D.; Holman, F. M.D.; Nieuwenhuijzen, G. A. P. Ph.D.; Rutten, H. J. T. Ph.D.; Nienhuijs, S. W. Ph.D.

Section Editor(s): Hull, Tracy

Diseases of the Colon & Rectum: January 2012 - Volume 55 - Issue 1 - p 90–95
doi: 10.1097/DCR.0b013e3182334121
Dynamic Article

BACKGROUND: A perineal hernia can severely disable everyday activities. Its repair is a surgical challenge, and guidance by the literature is limited. The series described so far are small or encompass a long period in which even nonmesh techniques were used.

OBJECTIVE: The aim of this study was to review recent results of a perineal mesh-based repair.

PATIENTS: Medical charts of patients with a symptomatic perineal hernia after abdominoperineal resection due to rectal cancer were reviewed.

MAIN OUTCOME MEASURES: Data included patients' characteristics, operative details, recurrence, and complications.

RESULTS: In total, 29 patients underwent repair of a symptomatic perineal hernia after an abdominoperineal resection due to rectal cancer. The majority was male (66%), and the median age was 59 years (range, 41–83). All patients received neoadjuvant treatment.

From 2003 until 2006, polytetrafluoroethylene or Vypro mesh and Prolene 2.0 sutures were used for perineal hernia repair. All 8 repairs failed; repeated repair using various methods was successful in 63%. After 2006, the surgical technique was changed into a high-tension repair with the use of a nonabsorbable mesh. This technique was successful for 20 of 21 patients (95%). Complications encountered in the entire group of 29 patients were urinary retention (n = 2), wound infection, seroma, and fistula (n = 1 each).

LIMITATIONS: Even though this is the largest group described in the literature, the results are limited because of the small number of patients.

CONCLUSION: Repair of perineal hernia remains challenging and only a few reports offer advice on how to manage this unusual problem. However, superior results have been shown with the new mesh-based technique through perineal approach with only 5% recurrence.

Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands

Financial Disclosures: None reported.

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Correspondence: S. W. Nienhuijs, Ph.D., Catharina Hospital Eindhoven, Department of Surgery, Postbox 1350, 5602 ZA, Eindhoven, The Netherlands. E-mail: s.nienhuijs@hccnet.nl

© The ASCRS 2012