Abstract
Background
The incidence of perineal hernia after abdominoperineal excision and extralevator abdominoperineal excision ranges from 1 to 26%. In this systematic review, we compared surgical options and postoperative outcomes of perineal hernia repair in this setting from 2012 to 2016 with findings in a review of publications 1944–2011.
Methods
We searched the PubMed database using the keywords “hernia” AND “perineum” identified 392 papers published from 1946 to 2016. Two hundred and ninety-six papers published before 2012 were excluded and 96 were found to be potentially relevant.
Results
Twenty-one studies with a total of 108 patients were included in the final analysis. Perineal hernia repair was performed using the perineal approach in 75 patients (69.44%), the laparoscopic approach in 25 patients (23.14%), the open abdominal approach in three patients (2.77%) and the laparoscopic perineal approach in three patients (2.77%) and the open abdominoperineal approach in two patients (1.8%). Non-absorbable mesh was used in 41 (37.96%) of cases, composite mesh in 20 (18.51%) and biological mesh in 19 (17.59%). Flap reconstruction was used in 25 patients (23.14%). First and second recurrences were observed in 26 (24.07%) and 7 (26.92%) cases, respectively.
Conclusions
Comparison of perineal hernia repair from 1944 to 2011 and from 2012 to 2016 showed that perineal and laparoscopic approaches are currently the most commonly used techniques. Primary defect closure was abandoned in favor of synthetic or composite mesh placement. Use of flap reconstruction spread rapidly and the recurrence rate was low. Randomized control trials and a larger sample size are needed to confirm these data and to develop a gold standard treatment for secondary hernia repair after abdominoperineal excision or extralevator abdominoperineal excision.
Similar content being viewed by others
References
Goedhart-de Haan AM, Langenhoff BS, Petersen S, Verheijen PM (2016) Laparoscopic repair of perineal hernia after abdominoperineal excision. Hernia 20(5):741–746. doi:10.1007/s10029-015-1449-3
Berendzen J, Copas P Jr (2013) Recurrent perineal hernia repair: a novel approach. Hernia 17(1):141–144. doi:10.1007/s10029-011-0821-1
Musters GD, Buskens CJ, Bemelman WA, Tanis PJ (2014) Perineal wound healing after abdominoperineal resection for rectal cancer: a systematic review and meta-analysis. Dis Colon Rectum 57(9):1129–1139. doi:10.1097/DCR.0000000000000182
Sayers AE, Patel RK, Hunter IA (2015) Perineal hernia formation following extraelevator abdominoperineal excision. Colorectal Dis 17(4):351–355. doi:10.1111/codi.12843
Holm T, Ljung A, Häggmark T, Jurell G, Lagergren J (2007) Extended abdominoperineal resection with gluteus maximus flap reconstruction of the pelvic floor for rectal cancer. Br J Surg 94(2):232–238
Musters GD, Lapid O, Stoker J, Musters BF, Bemelman WA, Tanis PJ (2016) Is there a place for a biological mesh in perineal hernia repair? Hernia 20(5):747–754. doi:10.1007/s10029-016-1504-8
Musters GD, Klaver CE, Bosker RJ, Burger JW, van Duijvendijk P, van Etten B, van Geloven AA, de Graaf EJ, Hoff C, Leijtens JW, Rutten HJ, Singh B, Vuylsteke RJ, de Wilt JH, Dijkgraaf MG, Bemelman WA, Tanis PJ (2016) Biological mesh closure of the pelvic floor after extralevator abdominoperineal resection for rectal cancer: a multicenter randomized controlled trial (the BIOPEX-study). Ann Surg [Epub ahead of print]
Mjoli M, Sloothaak DA, Buskens CJ, Bemelman WA, Tanis PJ (2012) Perineal hernia repair after abdominoperineal resection: a pooled analysis. Colorectal Dis 14(7):e400–e406. doi:10.1111/j.1463-1318.2012.02970.x
Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA, Thacker SB (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group. JAMA 283(15):2008–2012
Jenkins JT (1946) Postoperative hernia following abdominal perineal resection. Am J Surg 71:84–90
Martijnse IS, Holman F, Nieuwenhuijzen GA, Rutten HJ, Nienhuijs SW (2012) Perineal hernia repair after abdominoperineal rectal excision. Dis Colon Rectum 55(1):90–95. doi:10.1097/DCR.0b013e3182334121
Battaglia L, Muscarà C, Rampa M, Gasperini P, Vannelli A (2012) Small bowel occlusion due to giant perineal hernia: abdominal approach with plastic perineal reconstruction. G Chir 33(5):175–178
Fallis SA, Taylor LH, Tiramularaju RM (2013) Biological mesh repair of a strangulated perineal hernia following abdominoperineal resection. J Surg Case Rep. doi:10.1093/jscr/rjt023
Douglas SR, Longo WE, Narayan D (2013) A novel technique for perineal hernia repair. BMJ Case Rep. doi:10.1136/bcr-2013-008936
Saad A, Cece JA, Arvanitis ML, Elkwood AI (2013) The use of bone anchors for autologous flap fixation in perineal reconstruction: a case report. J Surg Case Rep. doi:10.1093/jscr/rjt063
Patel RK, Sayers AE, Gunn J (2013) Management of a complex recurrent perineal hernia. J Surg Case Rep. doi:10.1093/jscr/rjt056
Ali JM, Stabler A, Hall NR, Irwin M, Miller R, Fearnhead NS (2013) Tissue expanders: early experience of a novel treatment option for perineal herniation. Hernia 17(4):545–549. doi:10.1007/s10029-012-0939-9
Ong SL, Miller AS (2013) A transperineal approach to perineal hernia repair using suture anchors and acellular porcine dermal mesh. Tech Coloproctol 17(5):605–607. doi:10.1007/s10151-011-0774-5
Eriksen M, Bulut O (2014) Chemotherapy-induced enterocutaneous fistula after perineal hernia repair using a biological mesh: a case report. Int Med Case Rep J 7:11–13. doi:10.2147/IMCRJ.S54192
Ewan LC, Charleston PJ, Pettit SH (2014) Two case reports of perineal hernia after laparoscopic abdominoperineal resection with a proposed modification to the operative technique. Ann R Coll Surg Engl 96(2):e9–e10. doi:10.1308/003588414X13814021677476
Abbas Y, Garner J (2014) Laparoscopic and perineal approaches to perineal hernia repair. Tech Coloproctol 18(4):361–364. doi:10.1007/s10151-013-1060-5
Imagawa Y, Tomita K, Kitahara K, Yano K, Hosokawa K (2014) Repair of symptomatic perineal hernia with a titanium mesh. Hernia 18(4):587–590. doi:10.1007/s10029-013-1152-1
Pang J, Broyles JM, Berli J, Buretta K, Shridharani SM, Rochlin DH, Efron JE, Sacks JM (2014) Abdominal- versus thigh-based reconstruction of perineal defects in patients with cancer. Dis Colon Rectum 57(6):725–732. doi:10.1097/DCR.0000000000000103
Lee TG, Lee SJ (2014) Mesh-based transperineal repair of a perineal hernia after a laparoscopic abdominoperineal resection. Ann Coloproctol 30(4):197–200. doi:10.3393/ac.2014.30.4.197
Penkov N, Damianov D, Asenov Y, Gerzilov P, Sedloev T (2015) Recurrent perineal hernia—case report and review of the literature. Chirurgia (Bucur) 110(1):81–83
Allen SK, Schwab K, Day A, Singh-Ranger D, Rockall TA (2015) Laparoscopic repair of postoperative perineal hernia using a two-mesh technique. Colorectal Dis 17(3):O70–O73. doi:10.1111/codi.12873
Chelala E, Declercq S (2015) Laparoscopic repair of post-abdominoperineal resection hernia: biological mesh and augmentation technique. Hernia 19(5):853–856. doi:10.1007/s10029-013-1176-6
Harris CA, Keshava A (2015) Education and imaging. Gastrointestinal: laparoscopic repair of acute perineal hernia causing complete small bowel obstruction. J Gastroenterol Hepatol 30(12):1692. doi:10.1111/jgh.13035
Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group (2010) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg 8(5):336–341. doi:10.1016/j.ijsu.2010.02.007
Bullard KM, Trudel JL, Baxter NN, Rothenberger DA (2005) Primary perineal wound closure after preoperative radiotherapy and abdominoperineal resections has a high incidence of wound failure. Dis Colon Rectum 48(3):438–443
Artioukh DY, Smith RA, Gokul K (2007) Risk factors for impaired healing of the perineal wound after abdominoperineal resection of rectum for carcinoma. Colorectal Dis 9(4):362–367
Yang X, Jin C, Deng X, Wang M, Zhang Y, Wei M, Meng W, Wang Z (2016) Laparoscopic extralevator abdominoperineal excision of the rectum with primary suturing: short-term outcomes from single-institution study. J Laparoendosc Adv Surg Tech A 26(1):40–46. doi:10.1089/lap.2015.0325
West NP, Anderin C, Smith KJ, Holm T, Quirke P, European Extralevator Abdominoperineal Excision Study Group (2010) Multicentre experience with extralevator abdominoperineal excision for low rectal cancer. Br J Surg 97(4):588–599. doi:10.1002/bjs.6916
Jensen KK, Rashid L, Pilsgaard B, Møller P, Wille-Jørgensen P (2014) Pelvic floor reconstruction with a biological mesh after extralevator abdominoperineal excision to few perineal hernias and acceptable wound complication rates with minor movement limitations: single-centre experience including clinical examination and interview. Colorectal Dis 16(3):192–197. doi:10.1111/codi.12492
Ge W, Jiang SS, Qi W, Chen H, Zheng LM, Chen G (2017) Extralevator abdominoperineal excision for rectal cancer with biological mesh for pelvic floor reconstruction. Oncotarget 8(5):8818–8824. doi:10.18632/oncotarget.12502
Christensen HK, Nerstrøm P, Tei T, Laurberg S (2011) Perineal repair after extralevator abdominoperineal excision for low rectal cancer. Dis Colon Rectum 54(6):711–717. doi:10.1007/DCR.0b013e3182163c89
Foster JD, Pathak S, Smart NJ, Branagan G, Longman RJ, Thomas MG, Francis N (2012) Reconstruction of the perineum following extralevator abdominoperineal excision for carcinoma of the lower rectum: a systematic review. Colorectal Dis 14(9):1052–1059. doi:10.1111/j.1463-1318.2012.03169.x
Devulapalli C, Wei ATJ, DiBiagio JR, Baez ML, Baltodano PA, Seal SM, Sacks JM, Cooney CM, Rosson GD (2016) Primary versus flap closure of perineal defects following oncologic resection: a systematic review and meta-analysis. Plast Reconstr Surg 137(5):1602–1613. doi:10.1097/PRS.0000000000002107
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
This study has been approved by the appropriate ethics committee.
Informed consent
The informed consent statement was not included because this is a review of literature.
Rights and permissions
About this article
Cite this article
Balla, A., Batista Rodríguez, G., Buonomo, N. et al. Perineal hernia repair after abdominoperineal excision or extralevator abdominoperineal excision: a systematic review of the literature. Tech Coloproctol 21, 329–336 (2017). https://doi.org/10.1007/s10151-017-1634-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10151-017-1634-8