Laparoscopic repair of post-abdominoperineal resection hernia: biological mesh and augmentation technique

Perineal hernias are infrequent complications following abdominoperineal surgeries. These hernias require surgical repair when they become symptomatic by several conventional or reconstructive techniques. The benefits of a full laparoscopic approach and/or the combined approach of a perineal repair of the pelvic floor associated to the laparoscopic placement of a traditional synthetic mesh have been previously demonstrated. In this article, we present the case of a perineal incisional hernia, post-abdominoperineal resection of the rectum after radio chemotherapy, in the neoadjuvant treatment of a rectal adenocarcinoma tumor. An alternative approach, not previously described for the surgical repair of this type of hernia, is presented to assess the feasibility of the suturing repair, and efficacy of a biological acellular porcine collagen implant Permacol(®). A full laparoscopic suturing for the closure of the perineal defect associated to biological mesh reinforcement was successfully undertaken, with good short-term outcomes.