Laparoscopic repair of perineal hernia after abdominoperineal excision of the rectum and anus – a video vignette

Perineal hernia with bowel gangrene is uncommon but known complication of laparoscopic extralevator abdominoperineal excision (ELAPE). We present a rare case of closed loop small bowel obstruction with bowel gangrene secondary to an incarcerated perineal hernia that developed 7 years after an ELAPE. Intraoperatively, we found a definitive transition point due to adhesions in pelvis and a closed loop obstruction of the distal small bowel at different site with gangrenous intestine. She was managed successfully surgically with adhesiolysis and fixation of defect with biological mesh. Prevalence of perineal hernias will rise in future because of the increasing cases of ELAPE, in which no repair of pelvic floor is performed. The need of follow-up of these operations and more reporting of such cases are important in increasing awareness of these complications. Patients should be made aware of such complications and should seek urgent medical care.

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Response to Jensenet al. (2014): Pelvic floor reconstruction with a biological mesh after extralevator abdominoperineal excision leads tolow wound complications and perineal hernia rates with minor movement limitations

Colorectal Disease ◽

10.1111/codi.12591 ◽

2014 ◽

Vol 16 (7) ◽

pp. 563-564 ◽

Cited By ~ 1

Author(s):

G. D. Musters ◽

W. A. Bemelman ◽

P. J. Tanis

Keyword(s):

Pelvic Floor ◽

Abdominoperineal Excision ◽

Perineal Hernia ◽

Biological Mesh ◽

Wound Complications ◽

Pelvic Floor Reconstruction

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Dynamic Magnetic Resonance Imaging Demonstrates the Integrity of Perineal Reconstruction following Cylindrical Abdominoperineal Excision with Reconstruction of the Pelvic Floor Using Porcine Collagen

Case Reports in Medicine ◽

10.1155/2012/752357 ◽

2012 ◽

Vol 2012 ◽

pp. 1-5 ◽

Cited By ~ 6

Author(s):

D. O. Kavanagh ◽

H. Imran ◽

A. Almoudaris ◽

P. Ziprin ◽

O. Faiz

Keyword(s):

Pelvic Floor ◽

Clinical Evidence ◽

Digital Rectal Examination ◽

Dynamic Mri ◽

Posterior Wall ◽

Abdominoperineal Excision ◽

Perineal Hernia ◽

En Bloc ◽

Rectal Pain ◽

Radiological Staging

A 72-year-old female presented with a six-month history of increased frequency of defecation, rectal bleeding, and severe rectal pain. Digital rectal examination and endoscopy revealed a low rectal lesion lying anteriorly. This was confirmed histologically as adenocarcinoma. Radiological staging was consistent with a T3N2rectal tumour. Following long-course chemoradiotherapy repeat staging did not identify any metastatic disease. She underwent a laparoscopic cylindrical abdominoperineal excision withen blocresection of the coccyx and posterior wall of the vagina with a negative circumferential resection margin. The perineal defect was reconstructed with Permacol (biological implant, Covidien) mesh. She had no clinical evidence of a perineal hernia at serial followup. Dynamic MRI images of the pelvic floor obtained during valsalva at 10 months revealed an intact pelvic floor. A control case that had undergone a conventional abdominoperineal excision with primary perineal closure without clinical evidence of herniation was also imaged. This confirmed subclinical perineal herniation with significant downward migration of the bowel and bladder below the pubococcygeal line. We eagerly await further evidence supporting a role for dynamic MR imaging in assessing the integrity of a reconstructed pelvic floor following cylindrical abdominoperineal excision.

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Retrospective Analysis of Risk Factors for Postoperative Perineal Hernia After Endoscopic Abdominoperineal Excision for Rectal Cancer

10.21203/rs.3.rs-962418/v1 ◽

2021 ◽

Author(s):

Tatsuya Manabe ◽

Yusuke Mizuuchi ◽

Yasuhiro Tsuru ◽

Hiroshi Kitagawa ◽

Takaaki Fujimoto ◽

...

Keyword(s):

Risk Factors ◽

Rectal Cancer ◽

Regression Analysis ◽

Odds Ratio ◽

Open Surgery ◽

Abdominoperineal Excision ◽

Perineal Hernia ◽

Lower Rectal Cancer ◽

Peritoneal Closure ◽

Initial Surgery

Abstract Background: In contrast to open-surgery abdominoperineal excision (APE) for rectal cancer, postoperative perineal hernia (PPH) is reported to increase after extralevator APE and endoscopic surgery. In this study, therefore, we aimed to determine the risk factors for PPH after endoscopic APE.Methods: A total 73 patients who underwent endoscopic APE for lower rectal cancer were collected from January 2009 to March 2020, and the risk factors for PPH were analyzed retrospectively.Results: Nineteen patients (26%) developed PPH after endoscopic APE, and the diagnosis of PPH was made at 9–393 days (median: 183 days) after initial surgery. Logistic regression analysis showed that absence of pelvic peritoneal closure alone increased the incidence of PPH significantly (odds ratio; 13.76, 95% confidence interval; 1.48–1884.84, p = 0.004).Conclusions: Pelvic peritoneal closure should be performed when possible after endoscopic APE to prevent PPH.

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