Update in the management of secondary perineal hernia: experience in an abdominal wall unit with a series of 11 cases

Abstract

Introduction: Secondary perineal hernia is a defect of the pelvic floor originating after pelvic surgery, usually after an abdominal-perineal amputation. Its incidence is higher in patients treated with radiotherapy, after infection of the perineal wound and in extralift or cylindrical amputations, because the resection is more extensive and the muscle defect is greater. Its repair can be done by placing a prosthesis by the abdominal route (open vs. laparoscopic) or by a perineal approach. Objective: It is to update the subject and evaluate the efficacy of the perineal approach as a treatment for secondary perineal hernia. Material and method: Retrospective observational study of patients operated on for perineal hernia secondary to abdominoperineal rectum amputation, between June 2011 and June 2018. Asymptomatic patients are excluded. Main variable: recurrence of eventration. Secondary variables: characteristics of the patients, initial surgery, neo and adjuvant treatments, size of the defect, time of onset, symptoms, postoperative complications, days of drainage and hospital stay, recurrence and follow-up time. A comprehensive review of the literature is carried out. Results: Eleven patients with symptomatic hernia, four abdominal routes (3 laparoscopic and 1 open), and 7 perineal route were operated. Two recurrences were observed in the abdominal approach group (1 open and 1 laparoscopic). We have not found recurrences with the perineal approach (Martijnse technique). There is no consensus in the literature regarding the approach or the technique of choice. Conclusions: It is necessary to individualize each case, according to the experience of the surgical team, the patient’s conditions and depending on the need to jointly practice other abdominal procedures. After abdominal hernia recurrence, the perineal approach is a good option. The Martijnse technique is safe, effective and reproducible.