Laparoscopic repair of postoperative perineal hernia

Background: Perineal hernia is an uncommon complication following abdominoperineal resection of the rectum. There are only a few reports concerning the management of this unusual problem. Various methods of repair have been described, but none of them is well established. The purpose of our study is to present our experience and to discuss the pathogenesis and the different surgical repair techniques of these hernias. Methods: Between September 2003 and December 2004, four patients with perineal hernia observed several months following laparoscopic abdominoperineal resection for adenocarcinoma of the lower rectum were treated. All patients underwent the transabdominal laparoscopic approach using synthetic mesh for repair. Results: In all patients, the hernia was repaired by the laparoscopic transabdominal approach using synthetic mesh. The blood loss was minimal and mean operating time was 54 +/- 10 min. There were no cases that required conversion to laparotomy and there were no intraoperative or postoperative complications. Beginning of soft diet intake and ambulation times were on the second day following surgery. The average length of hospital stay was 4 +/- 1 days. During 8.3 +/- 6 months of follow-up, there was no recurrence of the hernia. Conclusion: Perineal hernias are rare complications of major pelvic surgeries. Symptomatic hernias should be repaired surgically. The transabdominal laparoscopic approach using synthetic mesh provides an appropriate solution for these hernias.