Transperineal Repair of Secondary Perineal Hernia Using a Mesh with a Memory-recoil Ring

Overview

Journal J Anus Rectum Colon

Specialty General Surgery

Date 2023 Oct 30

PMID 37900698

Authors

Katsuhito Suwa

Takanori Kurogochi

Takuro Ushigome

Hiroya Enomoto

Tomoyoshi Okamoto

Ken Eto

Affiliations

Soon will be listed here.

Abstract

Objectives: The aim of this study was to evaluate the effectiveness of transperineal repair of secondary perineal hernia (SPH) using a mesh with a memory-recoil ring.

Methods: Seven patients with SPH who underwent transperineal repair (TPR) between July 2010 and May 2022 were retrospectively analyzed. TPR was performed using a mesh with a memory-recoil ring.

Results: All SPHs developed after abdominoperineal resections in patients with anorectal malignancies. The median longitudinal and transverse diameters of the hernia orifice were 8 (7-10) cm and 6 (5-7) cm, respectively. In all cases, the mesh was fixed to the ischial tuberosity, residual levator muscle, coccygeus muscle, and coccyx after thorough dissection of the sac. The median operation time was 154 (142-280) min. Perioperative complications occurred in 2 cases (29%). One was enterotomy, which caused postoperative mesh infection requiring extraction of the mesh. The other was vaginal injury, which resulted in vaginal fistula but closed spontaneously. The median postoperative length of stay was 9 (5-14) days. No recurrence was observed during a median follow-up of 35 (9-151) months.

Conclusions: TPR using a mesh with a memory-recoil ring is safe, feasible and promising technique for SPH repairs.

References

Stamatiou D, Skandalakis J, Skandalakis L, Mirilas P . Perineal hernia: surgical anatomy, embryology, and technique of repair. Am Surg. 2010; 76(5):474-9. View

Wiegering A, Schlegel N, Isbert C, Jurowich C, Doht S, Germer C . Lessons and challenges during a 5-year follow-up of 21 Composix Kugel implantations. Hernia. 2013; 17(4):435-43. DOI: 10.1007/s10029-013-1096-5. View

Rajabaleyan P, Dorfelt A, Poornoroozy P, Vadgaard Andersen P . Robot-assisted laparoscopic repair of perineal hernia after abdominoperineal resection: A case report and review of the literature. Int J Surg Case Rep. 2019; 55:54-57. PMC: 6351357. DOI: 10.1016/j.ijscr.2018.12.009. View

Berrevoet F, Van den Bossche B, De Baerdemaeker L, de Hemptinne B . Laparoscopic evaluation shows deficiencies in memory ring deployment during small ventral hernia repair. World J Surg. 2010; 34(7):1710-5. DOI: 10.1007/s00268-010-0600-7. View

Bittner R, Bain K, Bansal V, Berrevoet F, Bingener-Casey J, Chen D . Update of Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (International Endohernia Society (IEHS))-Part A. Surg Endosc. 2019; 33(10):3069-3139. PMC: 6722153. DOI: 10.1007/s00464-019-06907-7. View

Hung L, Abbass M, Sapci I, Shawki S, Steele S, Gorgun E . Surgical Repair of Postoperative Perineal Hernia: A Case for the Perineal Approach. Dis Colon Rectum. 2021; 65(5):727-734. DOI: 10.1097/DCR.0000000000002374. View

Habr-Gama A, Sao Juliao G, Mattacheo A, Campos-Lobato L, Aleman E, Vailati B . Extralevator Abdominal Perineal Excision Versus Standard Abdominal Perineal Excision: Impact on Quality of the Resected Specimen and Postoperative Morbidity. World J Surg. 2017; 41(8):2160-2167. DOI: 10.1007/s00268-017-3963-1. View

West N, Anderin C, Smith K, Holm T, Quirke P . Multicentre experience with extralevator abdominoperineal excision for low rectal cancer. Br J Surg. 2010; 97(4):588-99. DOI: 10.1002/bjs.6916. View

Narang S, Alam N, Kockerling F, Daniels I, Smart N . Repair of Perineal Hernia Following Abdominoperineal Excision with Biological Mesh: A Systematic Review. Front Surg. 2016; 3:49. PMC: 5011127. DOI: 10.3389/fsurg.2016.00049. View

10.

Sharabiany S, Brouwer T, Kreisel S, Musters G, Blok R, Hompes R . Mesh, flap or combined repair of perineal hernia after abdominoperineal resection - A systematic review and meta-analysis. Colorectal Dis. 2022; 24(11):1285-1294. PMC: 9796945. DOI: 10.1111/codi.16224. View

11.

Walming S, Angenete E, Block M, Bock D, Gessler B, Haglind E . Retrospective review of risk factors for surgical wound dehiscence and incisional hernia. BMC Surg. 2017; 17(1):19. PMC: 5320761. DOI: 10.1186/s12893-017-0207-0. View

12.

Mjoli M, Sloothaak D, Buskens C, Bemelman W, Tanis P . Perineal hernia repair after abdominoperineal resection: a pooled analysis. Colorectal Dis. 2012; 14(7):e400-6. DOI: 10.1111/j.1463-1318.2012.02970.x. View

13.

Sayers A, Patel R, Hunter I . Perineal hernia formation following extralevator abdominoperineal excision. Colorectal Dis. 2014; 17(4):351-5. DOI: 10.1111/codi.12843. View

14.

Musters G, Buskens C, Bemelman W, Tanis P . Perineal wound healing after abdominoperineal resection for rectal cancer: a systematic review and meta-analysis. Dis Colon Rectum. 2014; 57(9):1129-39. DOI: 10.1097/DCR.0000000000000182. View

15.

Maspero M, Heilman J, Otero Pineiro A, Steele S, Hull T . Techniques of perineal hernia repair: A systematic review and meta-analysis. Surgery. 2022; 173(2):312-321. DOI: 10.1016/j.surg.2022.10.022. View

16.

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(5):329-336. DOI: 10.1007/s10151-017-1634-8. View