Perineal hernia repair after abdominoperineal resection: a pooled analysis
M. Mjoli
Department of Surgery, Pietermaritzburg Hospital Complex, University of KwaZulu Natal, Durban, South Africa
Search for more papers by this authorD. A. M. Sloothaak
Department of Surgery, Academic Medical Centre at the University of Amsterdam, Amsterdam, The Netherlands
Search for more papers by this authorC. J. Buskens
Department of Surgery, Academic Medical Centre at the University of Amsterdam, Amsterdam, The Netherlands
Search for more papers by this authorW. A. Bemelman
Department of Surgery, Academic Medical Centre at the University of Amsterdam, Amsterdam, The Netherlands
Search for more papers by this authorP. J. Tanis
Department of Surgery, Academic Medical Centre at the University of Amsterdam, Amsterdam, The Netherlands
Search for more papers by this authorM. Mjoli
Department of Surgery, Pietermaritzburg Hospital Complex, University of KwaZulu Natal, Durban, South Africa
Search for more papers by this authorD. A. M. Sloothaak
Department of Surgery, Academic Medical Centre at the University of Amsterdam, Amsterdam, The Netherlands
Search for more papers by this authorC. J. Buskens
Department of Surgery, Academic Medical Centre at the University of Amsterdam, Amsterdam, The Netherlands
Search for more papers by this authorW. A. Bemelman
Department of Surgery, Academic Medical Centre at the University of Amsterdam, Amsterdam, The Netherlands
Search for more papers by this authorP. J. Tanis
Department of Surgery, Academic Medical Centre at the University of Amsterdam, Amsterdam, The Netherlands
Search for more papers by this authorAbstract
Aim The purpose of this study was to determine treatment characteristics and clinical outcome for patients with perineal hernia after abdominoperineal excision (APE).
Method A systematic search of the literature revealed 40 individually documented patients, published between 1944 and 2010. Three additional patients treated at our centre were added. Patient characteristics, type of repair and outcome were entered into a database and a pooled analysis of these 43 patients was performed.
Results The pooled analysis revealed a median time interval of 8 months between APE and surgical repair of perineal hernia. The surgical approaches were perineal in 22 patients, open abdominal in 11, open abdominoperineal in three, laparoscopic in five and laparoscopic-perineal in two patients. A primary recurrence was documented in 13 patients and a second recurrence in three. The recurrence rate was 5/25 for synthetic or biological mesh, 6/12 for primary closure and 2/6 for the remaining techniques. Recurrent perineal hernia was repaired using a synthetic or biological mesh (n = 6), primary closure (n = 5) or a muscle flap (gluteus or gracilis; n = 4).
Conclusion From these limited and biased data based on published case descriptions, it appears that the recurrence rate of primary perineal hernia repair after APE is lower with the use of a mesh or other assisted closure than with primary suture repair.
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