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Management of a complex recurrent perineal hernia
Rikesh K Patel1, Adele E Sayers2, James Gunn2
1Academic Surgical Unit, Castle Hill Hospital, Cottingham, UK rikeshpatel@doctors.net.uk.
Journal of Surgical Case Reports
|June 26, 2014
Summary
Recurrent perineal hernias can occur after rectal excision surgery. A rectus flap repair successfully treated a complex case, suggesting plastic surgeon involvement may improve outcomes.
Area of Science:
- Surgical Oncology
- Colorectal Surgery
- Hernia Repair
Background:
- Perineal hernias are uncommon but debilitating complications following rectal excision surgery.
- Laparoscopic-assisted extralevator abdominoperineal excision (ELAPE) is a surgical technique for rectal cancer.
- Management of recurrent perineal hernias after ELAPE remains challenging.
Observation:
- A 79-year-old male developed a symptomatic perineal hernia post-ELAPE.
- Initial myocutaneous flap repair failed, with recurrent hernia confirmed by MRI.
- The hernia involved non-compromised bowel extending into the thigh musculature.
Findings:
- A subsequent rectus flap repair achieved a hernia-free status at 15 months.
- This case highlights the complexity of recurrent perineal hernias post-ELAPE.
- Optimal surgical techniques for prevention and management are not yet standardized.
Implications:
- Primary reconstruction during ELAPE may reduce hernia incidence.
- Multidisciplinary input, particularly from Plastic Surgery, is recommended for complex cases.
- Prompt and effective surgical repair is crucial for managing debilitating perineal hernias.
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