Perineal hernia – hernia repair using rectus abdominis muscle flap

Česká verze

Authors: M. Bockova; J. Hoch; L. Frajer
Authors place of work: Chirurgická klinika 2. LF Univerzity Karlovy a FN Motol, Praha přednosta: prof. MUDr. J. Hoch, CSc.
Published in the journal: Rozhl. Chir., 2016, roč. 95, č. 5, s. 206-209.
Category: Kazuistika

Summary

Perineal hernia is defined as a protrusion of intra-abdominal viscera through a defect in the pelvic floor. Primary hernias are extremely rare; secondary (postoperative) hernias following pelvic surgery, especially abdominoperineal resection or pelvic exenteration, are more common. Impaired perineal wound healing and neoadjuvant chemoradiotherapy in cancer patients are defined as main risk factors. A growing incidence of this complication is expected in connection with an increasing use of laparoscopic approaches and ELAPE. Despite the considerable time since the first described secondary perineal hernia in literature, patient series, prospective studies and treatment guidelines are still missing. The authors present a case of a 66-year-old man with secondary perineal hernia following a previous laparoscopic abdominoperineal resection for rectal cancer undergoing a surgical intervention. This was performed through an abdominal approach using a rectus abdominis muscle flap to repair the pelvic floor defect.

Key words:
perineal hernia – hedrocele – RAM – abdominoperineal resection

Zdroje

1. Maull KI, Fleishman HA. Hedrocele: report of a case and review of the literature. Dis Colon Rectum 1978;21:107−9.

2. Aboian E, Winter DC, Metcalf DR, et al. Perineal hernia after proctectomy: prevalence, risks, and management. Dis Colon Rectum, 2006;49:1564−8.

3. Novák J. Základy proktologie. Praha, Avicenum 1985:90−3.

4. Yeomans F. Levator hernia, perineal and pudendal. The American Journal of Surgery 1939;43:695−7.

5. Remzi FH, Oncel M, Wu JS. Meshless repair of perineal hernia after abdominoperineal resection: case report. Tech Coloproctol 2005; 9:142−4.

6. Abbas Y, Garner J. Laparoscopic and perineal approaches to perineal hernia repair. Tech Coloproctol 2014;18:361−4.

7. Erdmann MW, Waterhouse N. The transpelvic rectus abdominis flap: its use in the reconstruction of extensive perineal defects. Ann R Coll Surg Engl 1995;77:229−32.

8. Akatsu T, Murai S, Kamiya S, et al. Perineal hernia as a rare complication after laparoscopic abdominoperineal resection: report of a case. Surg Today 2009;39:340−3.

9. Ewan LC, Charleston PJ, Pettit SH. Two case reports of perineal hernia after laparoscopic abdominoperineal resection with a proposed modification to the operative technique. Ann R Coll Surg Engl 2014;96:9−10.

10. Ryan S, Kavanagh DO, Neary PC. Laparoscopic repair of postoperative perineal hernia. [online] Case Rep Med, 2010. [cit. 2016-02-24]. Dostupný z www: http://www.ncbi.nlm.nih.gov/pubmed/20811618.

11. Skipworth RJ, Smith GH, Anderson DN. Secondary perineal hernia following open abdominoperineal excision of the rectum: report of a case and review of the literature. Hernia 2007;11541−5.

12. Patel RK, Sayers AE, Gunn J. Management of a complex recurrent perineal hernia. [online] J Surg Case Rep 2013; [cit. 2016-02-24]. Dostupný z www: <http://www.oclc.org/oclc/man/9256cat/toc.htm>.

13. Chelala E, Declercq S. Laparoscopic repair of post-abdominoperineal resection hernia: biological mesh and augmentation technique. Hernia 2015;19:853−6.

14. Imagawa Y, Tomita K, Kitahara K, et al. Repair of symptomatic perineal hernia with a titanium mesh. Hernia 2014;18:587−90.

15. Kathju S, Lasko L, Medich DS. Perineal hernia repair with acellular dermal graft and suture anchor fixation. Hernia 2011;15:357−60.

16. Preiss A, Herbig B, Dorner A. Primary perineal hernia: a case report and review of the literature. Hernia 2006;10:430−3.

17. Washiro M, Shimizu H, Katakura T, et al. Using the uterus to close a pelvic defect after primary perineal posterior hernia repair: report of a case. Surg Today 2010;40:277−80.

18. Leroy J, D‘Urso A,Mutter D, et al. Multi-recurring perineal hernia after abdominoperineal resection: use of breast prosthesis implant [online]. WebSurg.com 2014, Dostupný z www: http://www.websurg.com/doi-vd01en4266.htm.

19. Brodbeck R, Brodbeck R, Horch RE, et al. Plastic and reconstructive surgery in the treatment of oncological perineal and genital defects. Front Oncol 2015;5:212.

20. Chong TW, Balch GC, Kehoe SM, et al. Reconstruction of large perineal and pelvic wounds using gracilis muscle klaps. Ann Surg Oncol 2015;22:3738−44.

21. Hoch J, Jech Z. Několik poznámek k diagnostice a léčbě pánevních a perineálních defektů a píštělí a k plastice lalokem z velkého sedacího svalu. Rozhledy v chirurgii 2000;79:363−5.