A Case of Perineal Hernia after Abdominoperineal Resection : Its Repair by Open Surgery with Laparoscopy

Abstract

The patient was a 73-year-old man who underwent abdominoperineal resection surgery for rectal cancer after preoperative chemoradiotherapy (45Gy + UFT 400mg/day). Although the rectal cancer was at the final stage IIIa, he could be discharged without any postoperative complication. However, he had a complaint of protruded perineum in the third month after the proctectomy and he was diagnosed as postoperative secondary perineal hernia. Since there appeared a pain due to the protrusion, he received surgical treatment, which was started by open laparotomy, but the pelvic cavity was too small and its bending in an anterior direction was very strong. Therefore, it was difficult to examine the anterior wall of pelvic cavity (the surfaces of seminal vesicle and prostate) and also the deep part of hernia cavity. Laparoscopic surgery was conducted to examine the deep region and plastic operation of the pelvic floor was performed with C-QUR Edge^TM Coating Mesh. The patient passed one year in satisfactory conditions and there was no recurrence of hernia after the operation. The secondary perineal hernia after abdominoperineal resection is a rare complication in general and its effective therapeutic procedure has not been established. Here, we report the present case with previous related reports.