Laparoscopic Repair of Perineal Hernia

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Abstract

Perineal hernia is a rare but known complication following major pelvic surgery. It may occur spontaneously or following abdominoperineal resection, sacrectomy, or pelvic exenteration. Very little is known about spontaneous perineal hernia. Surgical repair via open transabdominal and transperineal approaches has been previously described. We report laparoscopic repair of spontaneous and postoperative perineal hernia in 2 patients.

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Most cited references 17

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Postoperative perineal hernia.

Timothy M. Palmer, P Shellito, J. So (1997)

Perineal hernia is an uncommon complication following abdominoperineal resection. The aim of the study was to evaluate the predisposing factors and the optimum method of repair. A retrospective review of patients with postoperative perineal hernia at the Massachusetts General Hospital between 1963 and 1995 was performed. Twenty-one patients with perineal hernias were found. The original perineal operations were as follows: abdominoperineal resection in 13 patients, pelvic exenteration in 5 patients, cystourethrectomy in 2 patients, and perineal resection of the rectal stump in 1 patient. The incidence of symptomatic perineal hernia following abdominoperineal resection was estimated to be 0.62 percent. A total of 69 percent of patients had the original perineal wound left partially open, and in 10 percent it was left completely open. The peritoneal defect was not closed in 53 percent of patients, and only 21 percent had closure of the levator defect. Of the 19 patients who had hernia repair, 13 were repaired transperineally and 3 transabdominally and 3 required a combined abdominoperineal approach. The repair methods were as follows: simple closure of the pelvic defect (10 patients), mesh closure (5 patients), gluteus flap (1 patient), and retroflexion of the uterus (2 patients) or bladder (1 patient). Four patients had postoperative complications (mostly wound infections), and the recurrence rate was 16 percent. There was no difference in length of hospitalization among transperineal, transabdominal, and combined approaches. Primary closure of the perineal wound, with careful avoidance of wound infection is the most important consideration for avoiding a perineal hernia. Repair via the perineum with simple closure of the defect or a mesh is successful in most cases.

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Perineal herniorrhaphy: perioperative data from 100 dogs.

G Hosgood, C S Hedlund, R Pechman … (2016)

One hundred dogs (83 intact males, 15 castrated males, and two intact females) underwent 110 perineal herniorrhaphy procedures. Mixed-breed dogs (n = 32), miniature poodles (n = 14), Boston terriers (n = 11), and Pekingese (n = 9) were represented most frequently. Perineal swelling (n = 48) and a perineal defect on rectal palpation (n = 31) were common clinical signs. Twenty dogs had urinary bladder retroflexion and were significantly more likely to have elevated serum urea nitrogen and creatinine concentrations, hyperkalemia, hyperphosphatemia, and neutrophilic leukocytosis. Only five of 43 dogs evaluated radiographically had prostatomegaly. Of 30 dogs receiving oral barium, all had rectal deviation. The most frequent complications during the hospitalization period were incisional (n = 35), followed by rectal prolapse (n = 9), tenesmus (n = 8), and depression (n = 8). Fifty-six of 70 dogs with follow-up had no complications.

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Use of autogenous fascia lata graft for perineal herniorrhaphy in dogs.

Alexandre Bongartz, Francesca Carofiglio, Marc Balligand … (2016)

To evaluate the effectiveness of a herniorrhaphy technique, using an autogenous fascia lata graft (FLG) for perineal hernia (PH) repair in dogs. Prospective clinical study. Twelve dogs with PH. PHs were repaired with FLG harvested from the dog's ipsilateral thigh and sutured directly into the perineal defect. Correction of associated conditions, and castration were performed. Surgical time, pain, inflammation, pattern of defecation, lameness, hospitalization time, postoperative complications, and owner satisfaction were recorded. Histopathologic examination was performed in 1 dog euthanatized 10 months after repair. Hernia did not recur (mean follow-up, 5.8 months). Lameness was the most frequent minor complication, and was resolved within a few days. Transient rectal prolapse occurred in 2 dogs with bilateral PH. The mean (+/-SD) hospitalization was 1.8+/-0.9 days, and the surgical time was 76.5+/-9.8 minutes. Histopathologic examination in 1 dog revealed perfect integration of FLG into adjacent tissues without substantial tissue reaction. FLG reconstruction of PH is a simple, effective method of treatment. FLG can be used without major complications for primary repair of PH, as an augmentation procedure when the internal obturator muscle is thin or friable, or when herniation has recurred after another repair technique.

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Journal

Journal ID (nlm-ta): JSLS

Journal ID (iso-abbrev): JSLS

Journal ID (hwp): jsls

Journal ID (pmc): jsls

Journal ID (publisher-id): JSLS

Title: JSLS : Journal of the Society of Laparoendoscopic Surgeons

Publisher: Society of Laparoendoscopic Surgeons (Miami, FL )

ISSN (Print): 1086-8089

ISSN (Electronic): 1938-3797

Publication date (Print): Apr-Jun 2009

Volume: 13

Issue: 2

Pages: 237-241

Affiliations

Department of Surgery, Section of Colon and Rectal Surgery, Kaiser Permanente, Los Angeles, California, USA.

Author notes

Address correspondence to: Maher A. Abbas, MD, Chair, Center for Minimally Invasive Surgery, Department of Surgery Kaiser Permanente, 4760 Sunset Boulevard 3rd Floor, Los Angeles, California 90027, USA. Telephone: (323) 783-6848, Fax: (323) 783-8747; E-mail: maher.a.abbas@ 123456kp.org

Article

PMC ID: 3015944

PubMed ID: 19660225

SO-VID: 7fda7e41-e712-4401-ab04-f2b0854adedc

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This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License ( http://creativecommons.org/licenses/by-nc-nd/3.0/), which permits for noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited and is not altered in any way.

Laparoscopic Repair of Perineal Hernia

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25th European Students' Conference

Most cited references 17

Postoperative perineal hernia.

Perineal herniorrhaphy: perioperative data from 100 dogs.

Use of autogenous fascia lata graft for perineal herniorrhaphy in dogs.

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