Perineal hernia repair after abdominoperineal rectal excision.

Abstract

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. The aim of this study was to review recent results of a perineal mesh-based repair. Medical charts of patients with a symptomatic perineal hernia after abdominoperineal resection due to rectal cancer were reviewed. Data included patients' characteristics, operative details, recurrence, and complications. 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). Even though this is the largest group described in the literature, the results are limited because of the small number of patients. 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.