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. 2018:49:115-117.
doi: 10.1016/j.ijscr.2018.06.032. Epub 2018 Jun 28.

Laparoscopic repair with cone-shaped mesh implantation for perineal hernia occurred after laparoscopic abdominoperineal resection

Koichi Teramura  1 , Yusuke Watanabe  2 , Shintaro Takeuchi  3 , Fumitaka Nakamura  3 , Satoshi Hirano  4
Affiliations

Laparoscopic repair with cone-shaped mesh implantation for perineal hernia occurred after laparoscopic abdominoperineal resection

Koichi Teramura et al. Int J Surg Case Rep. 2018.

Abstract

Introduction: Perineal hernia after abdominoperineal resection (APR) is a rare complication, and no standard surgical procedures are established. We describe a simple laparoscopic mesh implantation technique utilizing a large synthetic flat mesh.

Presentation of case: We report a case of perineal hernia after APR. We performed laparoscopic repair using a soft and large synthetic mesh with simple technique. The essence of this technique is that mesh is inserted into the abdominal cavity without trimming and it forms in a conical shape to better adjust to the pelvic cavity.

Discussion: The perineal and laparoscopic approaches for perineal hernia repair have been performed most commonly in recent years, but the recurrence rate after repair remains high (24.1%). Using a large mesh could cover the hernial orifice with a sufficient margin, reducing a risk of recurrence caused by shrinkage and slippage of the mesh.

Conclusion: Our technique utilizing a large, lightweight, synthetic mesh can be practical and useful for perineal hernia repair after laparoscopic APR.

Keywords: Abdominoperineal resection; Laparoscopy; Mesh repair; Perineal hernia.

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Figures

Fig. 1
Fig. 1
Preoperative CT shows the protrusion of the small bowel through the pelvic floor into the perineal region.
Fig. 2
Fig. 2
Laparoscopic view of the pelvic cavity. A part of the hernial orifice was slightly visible by lifting the bladder.
Fig. 3
Fig. 3
Mesh covering the pelvic cavity. Arrows show the folded part of the mesh.
Fig. 4
Fig. 4
CT after 3 months from surgery shows the seroma in the perineal region and no recurrence of perineal hernia. Arrows show the hernial orifice.
Fig. 5
Fig. 5
A schema of a cone-shaped mesh.
See this image and copyright information in PMC

References

    1. Musters G.D., Buskens C.J., Bemelman W.A., Tanis P.J. Perineal wound healing after abdominoperineal resection for rectal cancer: a systematic review and meta-analysis. Dis. Colon. Rectum. 2014;57:1129–1139. - PubMed
    1. Balla A., Batista Rodriguez G., Buonomo N., Martinez C., Hernandez P., Bollo J. Perineal hernia repair after abdominoperineal excision or extralevator abdominoperineal excision: a systematic review of the literature. Tech. Coloproctol. 2017;21:329–336. - PubMed
    1. Agha R.A., Fowler A.J., Saeta A., Barai I., Rajmohan S., Orgill D.P. The SCARE statement: consensus-based surgical case report guidelines. Int. J. Surg. 2016;34:180–186. - PubMed
    1. Casasanta M., Moore L.J. Laparoscopic repair of a perineal hernia. Hernia. 2012;16:363–367. - PubMed
    1. Dulucq J.L., Wintringer P., Mahajna A. Laparoscopic repair of postoperative perineal hernia. Surg. Endosc. 2006;20:414–418. - PubMed