title: Incidence and management of perineal hernia after laparoscopic proctectomy.
abstract: Perineal hernia (PH) is formed by the protrusion of intra-abdominal viscera through a defect in the pelvic floor. This is a rare complication after conventional abdominoperineal resection, pelvic exanteration, proctectomy, and other pelvic procedures. The purpose of the present paper is to report 4 cases of PH after laparoscopic abdominoperineal resection for rectal cancer and to review literature data about the incidence, predisposing factors, and treatment of this challenging problem. When added to other 3 cases previously reported in the Brazilian series of laparoscopic surgery, this group of 7 cases comprises a PH incidence of 3.5% after rectal resection procedures. Surgical treatment is indicated only in symptomatic patients with no signs of cancer recurrence. Proposed methods of surgical repair include abdominal, perineal, or combined approaches to the hernia in association with the use of autologous tissues or prosthetic meshes. Preventive measures are represented by closure of the pelvic peritoneum whenever possible, primary perineal suture and wound care to avoid infection.
authors.affiliation: Colorectal Surgery Unit, Department of Gastroenterology of Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil. fgmcampos@terra.com.br
authors.forename: Fábio Guilherme C M
authors.initials: FG
authors.lastname: de Campos
authors.forename: Angelita
authors.initials: A
authors.lastname: Habr-Gama
authors.forename: Sérgio Eduardo
authors.initials: SE
authors.lastname: Araújo
authors.forename: Afonso Henrique da Silva E
authors.initials: AH
authors.lastname: Sousa
authors.forename: Caio Rizkallah
authors.initials: CR
authors.lastname: Nahas
authors.forename: Renato M
authors.initials: RM
authors.lastname: Lupinacci
authors.forename: Sérgio Carlos
authors.initials: SC
authors.lastname: Nahas
authors.forename: Desidério Roberto
authors.initials: DR
authors.lastname: Kiss
authors.forename: Joaquim
authors.initials: J
authors.lastname: Gama-Rodrigues
mesh_terms: D003082:Colectomy / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006547:Hernia / Q000453:epidemiology* / Q000209:etiology; D059685:Herniorrhaphy; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000009:adverse effects*; D008875:Middle Aged; D010502:Perineum; D012004:Rectal Neoplasms / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D013536:Suture Techniques