Our Summary

This research paper is a review of various studies that looked at how often perineal hernias (a type of hernia in the region between the anus and the genitals) recurred after different types of surgical repair techniques. The review considered studies where the hernia repair was done following abdominoperineal resection, a surgery often performed for rectal cancer that involves removal of the anus, rectum and part of the colon.

The study found that recurrence rates were quite high regardless of the technique used – whether it was using a biological mesh (a patch made from animal or human tissue), a synthetic mesh (a patch made from man-made materials), or a tissue flap (where a piece of the patient’s own tissue is used to cover the hernia). The recurrence rate was 39% for the biological mesh, 29% for the synthetic mesh, and 37% for the tissue flap alone. However, when a tissue flap was used in combination with a mesh, the recurrence rate dropped to 9%.

The results suggest that the combination of a tissue flap with a mesh might be the best approach for repairing perineal hernias, but the authors suggest that more research is needed to confirm this.

FAQs

  1. What is the recurrence rate of perineal hernia after different surgical techniques?
  2. Is there a difference in recurrence rates between biological and synthetic meshes in perineal hernia repair?
  3. Does the addition of a tissue flap to mesh repair reduce the recurrence rate of perineal hernia?

Doctor’s Tip

One helpful tip a doctor might tell a patient about proctectomy is to discuss the option of combining tissue flap reconstruction with mesh repair for perineal hernia to potentially lower the risk of recurrence. This combination approach has shown to have a lower recurrence rate compared to mesh repair alone. It is important to weigh the advantages and disadvantages of different surgical techniques and individualize the treatment plan based on the patient’s specific circumstances.

Suitable For

Patients who have undergone abdominoperineal resection (APR) for conditions such as cancer are typically recommended proctectomy. These patients may develop perineal hernias, which can be repaired using various surgical techniques including biological mesh closure, synthetic mesh closure, tissue flap reconstruction only, or tissue flap reconstruction combined with mesh. Recurrence rates after mesh repair of perineal hernia are high, but the addition of a tissue flap to mesh repair may have a more favourable outcome. Further investigation is needed to determine the most effective surgical technique for perineal hernia repair in these patients.

Timeline

Before proctectomy:

  1. Patient is diagnosed with a condition that requires proctectomy, such as rectal cancer.
  2. Patient undergoes preoperative evaluations and preparations, which may include imaging tests, blood work, and consultations with various healthcare providers.
  3. Patient receives counseling on the procedure, potential risks and benefits, and postoperative care.
  4. Patient undergoes proctectomy surgery, which involves removal of the rectum and possibly surrounding tissues.
  5. Patient may require a temporary or permanent ostomy, depending on the type of proctectomy performed.

After proctectomy:

  1. Patient is closely monitored in the hospital for complications and recovery from surgery.
  2. Patient receives pain management, wound care, and assistance with activities of daily living.
  3. Patient starts a gradual progression of diet and physical activity under the guidance of healthcare providers.
  4. Patient may undergo adjuvant therapy, such as chemotherapy or radiation, depending on the underlying condition.
  5. Patient attends follow-up appointments to monitor healing, manage symptoms, and address any concerns.
  6. Patient undergoes rehabilitation and counseling to adjust to any changes in bowel function or body image.
  7. Patient may experience long-term effects of proctectomy, such as changes in bowel habits, sexual function, and quality of life.

What to Ask Your Doctor

  1. What is the likelihood of experiencing a recurrence of perineal hernia after a proctectomy?
  2. What are the different surgical techniques available for perineal hernia repair after a proctectomy?
  3. What are the pros and cons of using biological mesh versus synthetic mesh for perineal hernia repair?
  4. What is the success rate of tissue flap reconstruction compared to mesh closure for perineal hernia repair?
  5. Are there any potential complications or risks associated with the different surgical techniques for perineal hernia repair?
  6. How long is the recovery time after undergoing surgery for perineal hernia repair?
  7. What are the chances of needing additional surgeries or treatments in the future after undergoing perineal hernia repair?
  8. How often should follow-up appointments be scheduled to monitor the success of the surgery and address any concerns or complications?
  9. Are there any lifestyle changes or precautions that should be taken after undergoing perineal hernia repair to prevent recurrence?
  10. Are there any alternative treatment options or therapies available for managing perineal hernia after a proctectomy?

Reference

Authors: Sharabiany S, Brouwer TPA, Kreisel SI, Musters GD, Blok RD, Hompes R, Tanis PJ. Journal: Colorectal Dis. 2022 Nov;24(11):1285-1294. doi: 10.1111/codi.16224. Epub 2022 Jul 6. PMID: 35712806