title: Is there a place for a biological mesh in perineal hernia repair?
abstract: This study aimed to determine the outcome of perineal hernia repair with a biological mesh after abdominoperineal resection (APR).
  
  
  
  All consecutive patients who underwent perineal hernia repair with a porcine acellular dermal mesh between 2010 and 2014 were included. Follow-up was performed by clinical examination and MRI.
  
  
  
  Fifteen patients underwent perineal hernia repair after a median of 25 months from APR. Four patients had a concomitant contaminated perineal defect, for which a gluteal fasciocutaneous flap was added in three patients. Wound infection occurred in three patients. After a median follow-up of 17 months (IQR 12-24), a clinically recurrent perineal hernia developed in 7 patients (47 %): 6 of 11 patients after a non-cross-linked mesh and 1 of 4 patients after a cross-linked mesh (p = 0.57). Routine MRI at a median of 17 months revealed a recurrent perineal hernia in 7 of 10 evaluable patients, with clinical confirmation of recurrence in 5 of these 7 patients. No recurrent hernia was observed in the three patients with combined flap reconstruction for contaminated perineal defects.
  
  
  
  A high recurrence rate was observed after biological mesh repair of a perineal hernia following APR.
authors.affiliation: Department of Surgery, Academic Medical Centre, University of Amsterdam, G4, Post box 22660, 1105 AZ, Amsterdam, The Netherlands.
authors.forename: G D
authors.initials: GD
authors.lastname: Musters
authors.affiliation: Department of Plastic and Reconstructive Surgery, Academic Medical Centre, University of Amsterdam, G4, Post box 22660, 1105 AZ, Amsterdam, The Netherlands.
authors.forename: O
authors.initials: O
authors.lastname: Lapid
authors.affiliation: Department of Radiology, Academic Medical Centre, University of Amsterdam, Post box 22660, 1105 AZ, Amsterdam, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Stoker
authors.affiliation: Department of Radiology, Medical Centre Alkmaar, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands.
authors.forename: B F
authors.initials: BF
authors.lastname: Musters
authors.affiliation: Department of Surgery, Academic Medical Centre, University of Amsterdam, G4, Post box 22660, 1105 AZ, Amsterdam, The Netherlands.
authors.forename: W A
authors.initials: WA
authors.lastname: Bemelman
authors.affiliation: Department of Surgery, Academic Medical Centre, University of Amsterdam, G4, Post box 22660, 1105 AZ, Amsterdam, The Netherlands. P.J.Tanis@amc.nl.
authors.forename: P J
authors.initials: PJ
authors.lastname: Tanis
mesh_terms: D062088:Acellular Dermis; D000368:Aged; D000818:Animals; D001705:Bioprosthesis; D005260:Female; D046449:Hernia, Abdominal / Q000601:surgery; D059685:Herniorrhaphy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010502:Perineum / Q000601:surgery*; D012004:Rectal Neoplasms / Q000601:surgery*; D012008:Recurrence; D013526:Surgical Mesh
keywords: Abdominoperineal resection; Biological mesh; Dynamic MRI; Hernia repair; Perineal hernia