A Perineal Hernia following Rectal Resection Successfully Repaired by the Combined Use of Laparoscopy and a Gluteal Fold Flap

Abstract

A 66-year-old man who had undergone laparoscopic abdominoperineal resection and open lower left lymph node dissection for rectal cancer was diagnosed with a perineal hernia on computed tomography one year postoperatively. The hernia increased gradually, and by 5 years postoperatively, his quality of life was severely impaired by a bulge in his perineum the size of a child's head and by pain from skin ulceration, curative treatment was performed. A mesh was placed laparoscopically to cover the hernia orifice in the pelvic floor, and this was covered by the greater omentum and reinforced from the perineal side with a gluteal fold flap, a skin flap containing a perforating branch of the internal pudendal artery. One year postoperatively, there has been no recurrence. This method was used in this case because a transabdominal approach alone entailed not just the risk of postoperative seroma, but also the risk that the repair would not withstand pressure from the abdominal organs, resulting in recurrence, and the use of a transperineal approach alone risked the repair being inadequate. The laparoscopic approach is useful from the viewpoints of minimal invasiveness and cosmetic results, and this method may be a useful procedure for treating postoperative perineal hernias. A search for case reports of perineal hernia in Japan was conducted, and the present case is reported along with a discussion of the literature.