Two Cases of Perineal Hernia after Abdominoperineal Resection Repaied Via a Transperineal Approach

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  • 経会陰的に修復を行った腹会陰式直腸切断術後会陰ヘルニアの2例
  • 症例 経会陰的に修復を行った腹会陰式直腸切断術後会陰ヘルニアの2例
  • ショウレイ ケイ エインテキ ニ シュウフク オ オコナッタ ハラ エインシキ チョクチョウ セツダン ジュツゴ エイン ヘルニア ノ 2レイ

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Abstract

Perineal hernia is a rare complication after abdominoperineal resection. No efficient surgical treatments have been established as yet and it recurs in a high frequency. Recently we have experienced two cases of perineal hernia after abdominoperineal resection. Case 1 involved a 75-year-old woman who developed a perineal hernia 3 months after laparoscopic abdominoperineal resection for rectal cancer. The hernia was repaired with mesh via a transperineal approach. The mesh was fixed by sutures using nonabsorbable ligature to the urogenital diaphragm and posterior wall of vagina in the anterior direction, to the sacrotuberous ligament in the lateral directions, and to the coccygeus periosteum in the posterior direction, for the reconstruction of the pelvic floor. Case 2 involved an 82-year-old man who developed a perineal hernia after open abdominoperineal resection at another hospital. We performed the same hernia repair with mesh via a transperineal approach as the Case 1 ; the mesh was fixed to the urogenital diaphragm in the anterior direction, to the sacrotuberous ligament in the lateral directions, and to the coccygeus periosteum in the posterior direction for the reconstruction.<BR>In order to prevent recurrence of perineal hernia after mesh repair, firm fixation of the mesh with nonabsorbable ligature to the sacrotuberous ligament in the lateral directions is very important, for that transperineal approach would be beneficial.

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