Perineal hernia repair after abdominoperineal rectal excision with prosthetic mesh-a single surgeon experience.

Aim: Extralevator abdominoperineal excision for rectal cancer is associated with an increased incidence of perineal hernia. The purpose of this study was to determine clinical outcome following perineal hernia repair with prosthetic mesh by a perineal open approach.

Methods: We present a case series of 10 patients who underwent 12 repairs of their hernia using a prosthetic mesh placed by a perineal open technique. Patients were identified from a prospectively maintained database and their case records were retrieved along with their imaging and analysed retrospectively.

Results: Perineal hernia incidence in our series is 10%. The median age was 73 ± 5.9 years. No gender predilection was found. The median time interval between extralevator abdominoperineal excision and surgical repair of perineal hernia was 25.3 months. The surgical approach was perineal with the use of a double layer prosthetic mesh. The recurrence ratio was 30% (n = 3). Overall morbidity was also 30% with no major complications (Clavien-Dindo I-II). Recurrence following primary repair was diagnosed in a median time interval of 28.3 ± 16.57 months. Two patients had repeat surgery to treat their recurrence.

Conclusions: Our small series supports the use of a prosthetic mesh repair of perineal hernias through a perineal approach. It is safe and effective with complication rates similar to those previously reported.