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. 2020 Jun;22(6):694-702.
doi: 10.1111/codi.14952. Epub 2020 Jan 23.

Further insights into the treatment of perineal hernia based on a the experience of a single tertiary centre

R D Blok  1   2 , T P A Brouwer  1 , S Sharabiany  1 , G D Musters  1 , R Hompes  1 , W A Bemelman  1 , P J Tanis  1
Affiliations

Further insights into the treatment of perineal hernia based on a the experience of a single tertiary centre

R D Blok et al. Colorectal Dis. 2020 Jun.

Abstract

Aim: There is little evidence concerning the optimal surgical technique for the repair of perineal hernia. This study aimed to report on the evolution of a technique for repair of perineal hernia by analysing the experience in a tertiary referral centre.

Method: This was a retrospective review of consecutive patients who underwent perineal hernia repair after abdominoperineal excision in a tertiary referral centre. The main study end-points were rate of recurrent perineal hernia, perineal wound complications and related re-intervention.

Results: Thirty-four patients were included: in 18 patients a biological mesh was used followed by 16 patients who underwent synthetic mesh repair. Postoperative perineal wound infection occurred in two patients (11%) after biological mesh repair compared with four (25%) after synthetic mesh repair (P = 0.387). None of the meshes were explanted. Recurrent perineal hernia following biological mesh was found in 7 of 18 patients (39%) after a median of 33 months. The recurrence rate with a synthetic mesh was 5 of 16 patients (31%) after a median of 17 months (P = 0.642). Re-repair was performed in four (22%) and two patients (13%), respectively (P = 0.660). Eight patients required a transposition flap reconstruction to close the perineum over the mesh, and no recurrent hernias were observed in this subgroup (P = 0.030). No mesh-related small bowel complications occurred.

Conclusion: Recurrence rates after perineal hernia repair following abdominoperineal excision were high, and did not seem to be related to the type of mesh. If a transposition flap was added to the mesh repair no recurrences were observed, but this finding needs confirmation in larger studies.

Keywords: Perineal hernia; abdominoperineal excision; biological mesh; mesh repair; synthetic mesh.

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Conflict of interest statement

The authors have no conflict of interest to declare.

Figures

Figure 1
Figure 1
Mid‐sagittal MRI image of a male patient with a recurrent perineal hernia after primary hernia repair using biological mesh, revealing a large omental hernia with remnants of the mesh (arrow) along the anterior border of the perineal defect. Perineal hernia was defined as visceral descent below the line between the perineal body and the coccyx (dashed line).
Figure 2
Figure 2
Kaplan–Meier curve showing the development of recurrence of perineal hernia over time after reconstruction of the perineum with biological mesh (green) or synthetic mesh (red).
See this image and copyright information in PMC

Comment in

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