Case Report: Combined Laparoscopic Perineal Hernia and Abdominal Parastomal Hernia Repair With a Mesh After Abdominoperineal Resection: A Video Vignette and Review of the Literature

Abstract

Background: Postoperative perineal hernia (PH) is an uncommon complication after abdominoperineal resection (APR). Different techniques have been described in literature and there is no consensus regarding the optimal repair approach. In the present study, we reported a case of a laparoscopic combined repair of a perineal hernia and abdominal parastomal hernia (PSH) with mesh. Studies have shown that the prosthetic PSH and PH repair can be performed at the same time by laparoscopy with the same trocars positioning, adding the advantages of minimally invasive surgery and avoiding large laparotomy.

Methods: A literature search in Pubmed was performed. All articles in English describe laparoscopic repair of combined perineal and parastomal hernias. A case presentation of an 83-year-old woman with combined parastomal and perineal hernias after abdominoperineal resection (APR) shown in a video vignette is provided.

Results: Three single patient case reports published between 2016 and 2023 were found in literature. Two patients with rectal cancer underwent APR procedure, while the third patient underwent an anterior pelvic exenteration (APE) for carcinoma of the urinary bladder (CUB). The laparoscopic procedures did not require conversion and all procedures successfully closed the defect using a mesh. In our case, the operative time was 3 h with the major time spent for PH repair. The intraoperative blood loss was non-significant and the postoperative course was regular. The patient has been discharged on the fourth postoperative day. At 1 year follow-up, the patient noticed a great improvement in her daily-life due to the absence of the previous discomforts and there was no evidence of early recurrence or other postoperative complications.

Conclusion: Combined laparoscopic transabdominal PH and PSH repair with the use of synthetic mesh was shown to be a safe and effective repair for this rare disorder. To accurately compare techniques, we require prospective studies with longer follow up durations.

Keywords: incisional hernia; laparoscopy; mesh; parastomal hernia; rectal cancer.

FIGURE 1

Pre-operative CT abdomen/pelvis showing the hernia defects. (A) Parastomal hernia. (B) Perineal hernia.

FIGURE 2

Post-operative MRI pelvis showing no perineal recurrence. Sagittal plane.