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Recurrent perineal hernia repair: a novel approach
1Department of Obstetrics and Gynecology, University of Tennessee Medical Center, Knoxville, TN 37920, USA. jberendz@mc.utmck.edu
Purpose:
Postoperative perineal hernias are rare complications from procedures, which compromise the pelvic floor, mainly abdominoperineal resection, proctocolectomy, and partial or total pelvic exenteration. Surgical repair can be accomplished through abdominal, laparoscopic, or transperineal approaches.
Methods:
We present a case report of a 70-year-old man who underwent two prior operations for recurrent perineal hernia and was ultimately successfully treated with a third operation, a synthetic mesh redo procedure that utilized a synthetic mesh system marketed for women with pelvic organ prolapse.
Results:
Although there is no "gold standard" for perineal hernia repair, our patient had multiple surgeries employing a variety of approaches. Final success was achieved using a mesh system with improved fixation to secure pelvic ligaments, using an exclusive perineal approach. Now, more than five years following the final surgery, the patient remains symptom free with no clinical evidence of perineal hernia recurrence.
Conclusions:
To date, this is the only report of using this mesh system in a male. The advantages of using this mesh system are (1) exclusive perineal approach without the accompanying risks of abdominal or laparoscopic approach; (2) improved fixation of mesh to secure pelvic ligaments; and (3) lightweight, flexible, and large mesh shape that can easily be trimmed to allow versatility in procedures.
Insights
A novel synthetic mesh system, originally for pelvic organ prolapse, successfully treated recurrent perineal hernia in a male patient. This approach offers improved fixation and avoids abdominal surgery risks.
Area of Science:
- Surgical innovation in reconstructive urology and gynecology.
- Pelvic floor reconstruction and hernia repair.
Background:
- Postoperative perineal hernias are rare but serious complications following pelvic surgeries like abdominoperineal resection.
- Surgical repair options include abdominal, laparoscopic, and transperineal approaches, with no universally established gold standard.
Observation:
- A 70-year-old male patient with recurrent perineal hernia underwent a third surgical repair.
- The procedure utilized a synthetic mesh system designed for pelvic organ prolapse in women.
Findings:
- The patient achieved successful repair using an exclusive transperineal approach with the synthetic mesh.
- The mesh system provided improved fixation to pelvic ligaments, leading to a durable, symptom-free outcome over five years post-surgery.
Implications:
- This case demonstrates the potential efficacy of using a female-indicated pelvic organ prolapse mesh for male recurrent perineal hernia repair.
- The transperineal approach with this mesh offers advantages including reduced surgical risks, enhanced mesh fixation, and procedural versatility.
