Case report of perineal hernia after laparoscopic abdominoperineal resection
Kumpei Honjo1, Kazuhiro Sakamoto1, Shunsuke Motegi1
1Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, Tokyo, Japan.
Abstract:
Perineal hernia (PH) is a rare complication following laparoscopic abdominoperineal resection (APR) for rectal cancer. We present a case report of perineal hernia after laparoscopic APR and discuss its management. The patient was a 77-year-old man who was diagnosed with lower rectal cancer. He underwent laparoscopic APR and bilateral lateral lymph node dissection. Two months after the surgery, pain and bulging in the perineal region developed, and PH was diagnosed by CT. Repair with a polypropylene mesh was performed using a combination of laparoscopic abdominal and transperineal approaches. Reportedly, the incidence of secondary PH after APR has increased along with the rate of laparoscopic surgery. Treatment of secondary PH with transperineal repair alone may cause injuries to other organs because of adhesion of the pelvic viscera. In the present case, we safely repaired the hernia repair using a laparoscopy-assisted perineal approach.
Insights
Perineal hernia (PH) is a rare complication after laparoscopic abdominoperineal resection (APR). A laparoscopy-assisted approach safely repaired a secondary PH, avoiding complications from transperineal repair alone.
Area of Science:
- Surgical Oncology
- Gastroenterology
- Medical Imaging
Background:
- Perineal hernia (PH) is a rare complication following laparoscopic abdominoperineal resection (APR) for rectal cancer.
- The incidence of secondary PH after APR is increasing with the rise in laparoscopic surgery rates.
Observation:
- A 77-year-old male diagnosed with lower rectal cancer underwent laparoscopic APR and bilateral lateral lymph node dissection.
- Two months post-surgery, the patient developed perineal pain and bulging, diagnosed as PH via CT scan.
Findings:
- The patient underwent successful repair of the secondary PH using a polypropylene mesh.
- A combined laparoscopic abdominal and transperineal approach was utilized for the repair.
Implications:
- Transperineal repair alone for secondary PH risks injury to pelvic viscera due to adhesions.
- A laparoscopy-assisted perineal approach offers a safe and effective method for managing secondary PH after laparoscopic APR.
