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Colorectal Dis. 2015 Mar;17(3):O70-3. doi: 10.1111/codi.12873.

Laparoscopic repair of postoperative perineal hernia using a two-mesh technique.

Author information

1
Department of Colorectal Surgery, Royal Surrey County Hospital, Guildford, UK.

Abstract

AIM:

Perineal herniation following abdomino-perineal excision of the rectum (APER) can be debilitating. Repair options include a transabdominal (laparoscopic or open), perineal or a combined approach, but there is no consensus on the optimal technique. We describe a novel laparoscopic two-mesh technique and short- to medium-term outcomes.

METHOD:

Six patients underwent this operation between 2008 and 2014. Patients were positioned in a modified Lloyd-Davies position, allowing perineal access, and steep Trendelenburg to aid displacement of small bowel from the pelvis. A polypropylene mesh was shaped, placed over the hernial defect, tacked postero-laterally and sutured antero-laterally to reconstitute the pelvic diaphragm. A second larger mesh (composite) was placed over the first supporting mesh and secured with tacks and sutures, overlapping the hernial defect, preventing small bowel contact with the mesh.

RESULTS:

The median time from the index operation to presentation of the hernia was 5 months. One patient with dense small bowel adhesions from the primary repair had a combined laparoscopic and perineal approach. The median operating time was 141 min and median length of stay was 3 days. There were no intra-operative complications and no recurrences over a follow-up of 1-76 months.

CONCLUSION:

We describe a novel laparoscopic technique for perineal hernia repair following APER with a low recurrence rate in the intermediate term.

KEYWORDS:

Hernia; laparoscopic; perineal

PMID:
25523927
DOI:
10.1111/codi.12873
[Indexed for MEDLINE]

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