Prevention of perineal hernia after laparoscopic and robotic abdominoperineal resection: review with illustrative case series of internal hernia through pelvic mesh

Prevention of perineal hernia after laparoscopic and robotic abdominoperineal resection: review with illustrative case series of internal hernia through pelvic mesh

Can J Surg 2016;59(1):54-58 | PDF

George Melich, MD*; Dae Ro Lim, MD*; Hyuk Hur, MD; Byung Soh Min, MD; Seung Hyuk Baik, MD; Goffredo O. Arena, MD; Philip H. Gordon, MD; Nam Kyu Kim, MD

Abstract

This review is intended to raise awareness of placing a pelvic mesh to prevent perineal hernias in cases of minimally invasive (MIS) abdominoperineal resections (APR) and, in doing so, causing internal hernias through the mesh. In this article, we review the published literature and present an illustrative series of 4 consecutive cases of early internal hernia through a pelvic mesh defect. These meshes were placed to prevent perineal hernias after laparoscopic or robotic APRs. The discussion centres on 3 key questions: Should one be placing a pelvic mesh following an APR? What are some of the technical details pertaining to the initial mesh placement? What are the management options related to internal hernias through such a mesh?

Résumé

L’objectif du présent examen est de sensibiliser les praticiens au risque associé à la pose d’un treillis pelvien visant à prévenir les hernies périnéales après une résection abdominopérinéale à effraction minimale, pratique qui peut entraîner une hernie interne. Nous nous penchons ici sur les articles publiés à ce sujet et présentons une série éloquente de 4 cas consécutifs de hernies internes précoces attribuables à un défaut du treillis. Les dispositifs avaient été mis en place pour prévenir une hernie périnéale après des résections laparoscopiques ou robotiques. La discussion porte sur 3 questions centrales : Devrait-on poser un treillis pelvien à la suite d’une résection abdominopérinéale? Quels sont les éléments techniques à surveiller lors de la pose initiale? Quelles sont les options de prise en charge des hernies internes causées par les treillis?


*These authors contributed to this work equally.

The information in this report was presented at the Canadian Association of General Surgeons (CAGS) annual conference held in Calgary, Alta., Sept. 13–16, 2012. Ideas generated during the presentation have been incorporated in this report.

Accepted for publication Oct. 21, 2015

Affiliations: From the Department of Surgery, Royal Columbian Hospital, University of British Columbia, Vancouver, BC (Melich); the Jewish General Hospital, McGill University, Montreal, QC (Gordon); the Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea (Lim, Hur, Min, Baik, Kim); and the McGill University Health Centre, McGill University, Montreal, QC (Arena).

Competing interests: None declared.

Contributors: All authors designed the study. G. Melich and D. Lim acquired and analyzed the data, which N. Kim also analyzed. G. Melich, D. Lim, G. Arena and P. Gordon wrote the article, which all authors reviewed and approved for publication.

DOI: 10.1503/cjs.003115

Correspondence to: G. Melich, Department of Surgery, Royal Columbian Hospital, University of British Columbia, 330 E Columbia St., New Westminster, BC, V3L 3W7; gmelich@hotmail.com