gms | German Medical Science

Background: Perineal hernia is an uncommon complication following abdominoperineal rectum resection. Several surgical procedures have been proposed for perineal hernia repair, including perineal, laparoscopic and abdominal approaches. Repair techniques can be classified into primary suture techniques, mesh placements and repairs with autogenous tissue.

Material/Method: We report a 68-year-old man with a perineal hernia, who underwent a pelvic floor reconstruction with a transperineal composite mesh and a gluteal fasciocutaneous rotation flap.

Results/Discussion: The usage of the gluteal fasciocutaneous flap for perineal closure in cases of insufficient soft tissue to cover the mesh bottom side is reported in the literature. The gluteal flap does not add any strength to the pelvic floor reconstruction but seems important to adequately cover the mesh with well-vascularized subcutaneous tissue to prevent seroma and abscess formation below the mesh and to close the perineal skin without tension. Several authors emphasize that the perineal approach should incorporate the placement of a mesh to reduce the re-recurrence rate. The use of biological meshes is associated with a high recurrence rate. On the other side, synthetic meshes are associated with high inflammation risk, infections and foreign body reactions. As there is no consensus among surgeons as to the optimal mesh, we decided to use a mesh that combines the advantages of both categories. A composite mesh offers a resorbable collagen barrier on one side to limit visceral attachments, and a three-dimensional polyester knit structure on the other to promote differentiated tissue ingrowth.

Conclusion: We conclude that a combined approach with transperineal mesh reconstruction and gluteal fasciocutaneous flap could be an alternative choice in perineal hernia repair after abdominoperineal resection.