Recurrent postoperative perineal hernia: laparoscopic redo mesh repair

Symptomatic perineal herniation after abdominoperineal resection is a rare complication and its management remains challenging. Recurrent symptomatic perineal hernia after a previous laparoscopic mesh repair is exceptional and no standardized procedure has been deemed the “gold standard of care.” To date, this redo laparoscopic mesh repair is only the second report that we could find in the English literature.     

Giant right post-traumatic diaphragmatic hernia: laparoscopic repair without a mesh

Diaphragmatic ruptures are fairly frequent after thoraco-abdominal traumas (0.8-5%). In 90% of cases, they are left-sided. In the literature, very few cases are treated by laparoscopy. The aim of this study was to evaluate the feasibility and effectiveness of laparoscopic repair of a giant right post-traumatic diaphragmatic hernia without the use of a mesh. We present the case of a 28-year-old male operated by the laparoscopic approach for a giant right post-traumatic diaphragmatic hernia, diagnosed 18 months after the trauma. Surgical repair was carried out by means of 10 non-absorbable interrupted stitches, without the use of a mesh. The duration of the operation was 145 minutes. The patient was discharged 3 days after the surgical procedure, and no complications occurred. After a 40-month follow-up, the patient is asymptomatic and healthy. Laparoscopic repair of post-traumatic diaphragmatic hernias without the use of a mesh is safe and effective and affords an early postoperative recovery.     

Perineal approach for polypropylene mesh repair of perineal hernia

This is the first case report of a perineal hernia repair following abdominoperineal excision of rectum employing a purely perineal approach for interposition of a mesh graft.     

Single-incision laparoscopic trans-abdominal pre-peritoneal mesh hernia repair: a feasible approach

Background  

Single-incision laparoscopic surgery (SILS) is aimed at improving the cosmetic outcome following surgery. If the incision is made through the umbilicus, the surgery is almost ‘scarless.’ This is increasingly being used for laparoscopic cholecystectomy with good cosmetic results without compromising the safety of the operation. The challenge of this surgery lies in manipulating instruments within the limitations of the closely inserted ports.     

Recurrent perineal hernia repair: a novel approach

Purpose

Postoperative perineal hernias are rare complications from procedures, which compromise the pelvic floor, mainly abdominoperineal resection, proctocolectomy, and partial or total pelvic exenteration. Surgical repair can be accomplished through abdominal, laparoscopic, or transperineal approaches.

Methods

We present a case report of a 70-year-old man who underwent two prior operations for recurrent perineal hernia and was ultimately successfully treated with a third operation, a synthetic mesh redo procedure that utilized a synthetic mesh system marketed for women with pelvic organ prolapse.

Results

Although there is no "gold standard" for perineal hernia repair, our patient had multiple surgeries employing a variety of approaches. Final success was achieved using a mesh system with improved fixation to secure pelvic ligaments, using an exclusive perineal approach. Now, more than five years following the final surgery, the patient remains symptom free with no clinical evidence of perineal hernia recurrence.

Conclusions

To date, this is the only report of using this mesh system in a male. The advantages of using this mesh system are (1) exclusive perineal approach without the accompanying risks of abdominal or laparoscopic approach; (2) improved fixation of mesh to secure pelvic ligaments; and (3) lightweight, flexible, and large mesh shape that can easily be trimmed to allow versatility in procedures.     

Ventral hernia repair by the laparoscopic approach

An analysis of these results indicates that laparoscopic hernia repair can be performed safely by experienced laparoscopic surgeons, and with lower perioperative complication rates than for open hernia repair. Although the follow-up period for the laparoscopic repair is only 2 or 3 years, the recurrence rate is likely lower than with open repair. Most patients with ventral hernias are candidates for this laparoscopic repair if safe access and trocar placement can be obtained. The choice of mesh often provokes a debate among surgeons, but little practical difference in the results seems to exist between the two types of mesh available. Although the ePTFE mesh has a good theoretic basis for promoting tissue ingrowth on the parietal side of the mesh and minimizing adhesions to the bowel side of the mesh, data indicate that no difference in outcome exists related to adhesions or fistula formation (Tables 1 and 2), so surgeon preference and cost of the prosthesis should be the deciding variables. Fistulas are of concern because of the experience with mesh in the trauma patient and in the treatment of severe abdominal wall infections, when abdominal wall reconstruction often is performed in contaminated wounds in the acute phases and leaves the mesh exposed without soft tissue coverage. These conditions do not apply for most cases of elective hernia repair. Laparoscopic ventral hernia repair offers advantages over the conventional open mesh repair and may decrease the hernia recurrence rate to 10% to 15%. When properly performed, the laparoscopic approach does not and should not compromise the principles for successful mesh repair of ventral hernias.     

Polyester composite mesh for laparoscopic paraesophageal hernia repair

Recent evidence supports the use of prosthetic reinforcement material during laparoscopic hiatal hernia repair; however, the search for appropriate prosthetic materials is still under investigation. In this article, the technical feasibility and the short-term outcomes of the use of polyester composite mesh for crural reinforcement was determined. A small series of patients with large paraesophageal hiatal hernias underwent laparoscopic repair with mesh (5 males; mean age = 62 +/- 10 years; mean body mass index = 29 +/- 1 kg/m2, and mean American Society of Anesthesiologists = 3 +/- .4). There were no postoperative complications, deaths, or evidence of hernia recurrence documented by barium study at a median follow-up of 9 months. The use of the polyester composite mesh is technically feasible, has excellent intracorporeal handling characteristics, and holds suture readily. The short-term outcomes of the use of the polyester composite mesh for paraesophageal hernia repair reinforcement appeared to be favorable and are encouraging.     

Lightweight versus heavyweight mesh in laparoscopic inguinal hernia repair: a meta-analysis

Background

Reinforcement of inguinal hernia repair with prosthetic mesh is standard practice but can cause considerable pain and stiffness around the groin and affect physical functioning. This has led to various types of mesh being engineered, with a growing interest in lighter-weight mesh. Minimally invasive approaches have also significantly reduced postoperative recovery from inguinal hernia repair. The aim of this systematic review was to compare the outcomes after laparoscopic inguinal repair using new lightweight or traditional heavyweight mesh in published randomised controlled trials.

Methods

Medline, Embase, trial registries, conference proceedings, and reference lists were searched for controlled trials of heavyweight versus lightweight mesh for laparoscopic repair of inguinal hernias. The primary outcomes were recurrence and chronic pain. Secondary outcomes were visual analogue pain score at 7?days postoperatively, seroma formation, and time to return to work. Risk differences were calculated for categorical outcomes and standardised mean differences for continuous outcomes.

Results

Eight trials were included in the analysis of 1,667 hernias in 1,592 patients. Mean study follow-up was between 2 and 60?months. There was no effect on recurrence [pooled analysis risk difference 0.00 (95% CI ?0.01 to 0.01), p?=?0.86] or chronic pain [pooled analysis risk difference ?0.02 (95% CI ?0.04 to 0.00); p?=?0.1]. Lightweight and heavyweight mesh repair had similar outcomes with regard to postoperative pain, seroma development, and time to return to work.

Conclusion

Both mesh options appear to result in similar long- and short-term postoperative outcomes. Further long-term analysis may guide surgeon selection of mesh weight for laparoscopic inguinal hernia repair.     

Laparoscopic repair of a perineal hernia

Introduction

Perineal hernias are rare occurrences with statistics ranging from <1 to 3% incidence after open abdominoperineal resection (APR). The incidence of perineal hernia after laparoscopic APR is less certain due to the relatively recent advent of laparoscopic proctectomy. Here we discuss an occurrence of a perineal hernia after a laparoscopic APR and its subsequent laparoscopic repair with mesh.

Discussion

Repair of a perineal hernia can be technically challenging, with a variety of approaches each with its own risk of potential complications. Laparoscopic advancements have allowed a theoretically less invasive approach while having greater view of the necessary anatomical landmarks to achieve safe and tension-free repair of such hernias.

Conclusion

There are several case reports available to describe perineal repair but the numbers remain skewed due to the sparse reporting of complications post APR surgery. This may in fact be due to the asymptomatic aspect these hernias can have. Laparoscopic repair is a challenging yet viable approach to the correction of such occurrences.     

Ileocutaneous fistula formation following laparoscopic polypropylene mesh hernia repair

A rare case of enterocutaneous fistula caused by chronic erosion of polypropylene mesh after laparoscopic repair of a recurrent inguinal hernia is described. Successful treatment was achieved by fistulectomy, total resection of the implanted mesh, and small-bowel segmental resection. The patient recovered well postoperatively, and at follow-up 18 months later, the herniorrhaphy has remained intact. This complication needs to be added to the differential diagnosis in patients who present inflammation, abscess formation, or cutaneous fistula following laparoscopic hernia repair. Received: 7 October 1996/Accepted: 14 October 1996     

Late rejection of the mesh after laparoscopic hernia repair

We report the first case of late rejection of a mesh after laparoscopic hernia repair. It occurred in a 48-year-old man who had had a laparoscopic hernia repair by transabdominal preperitoneal approach 3 years earlier. The most characteristic finding was the slow development of a firm mass in the right groin, without pain or fistula. At admission 3 months later, US and CT scans demonstrated a necrotic mass extending into both iliac fossa. The mass was approached through a midline incision. Pus was taken for microscopic examination (negative), and the mesh was removed, along with several staples. Ultramicroscopic examination of the mesh showed breakdown of the fibers, collagen reduction, and no chronic inflammatory cells. No infectious cause of inflammation was identified. Received: 5 May 1997/Accepted: 11 July 1997     

腹腔镜下造口旁疝补片修补术应用体会

目的探讨腹腔镜下造口旁疝修补术的临床效果。方法回顾性分析2007年9月至2010年4月期间8例行腹腔镜下造瘘口旁疝补片修补术患者的临床资料,分析手术情况、术后并发症及复发情况。结果 8例造口旁疝患者均在腹腔镜下修补成功。手术时间50～180min,平均135min。疝环大小4.5～6.5cm,平均5.0cm。术后1例出现肠梗阻及复发,后行腹腔镜探查及再次修补术。2例术后早期出现腹胀,1周后腹胀缓解。1例术后出现术区疼痛不适,对症治疗后缓解。本组未发生术区感染。住院时间5～14d,平均7.6d。术后随访1年,除1例复发后行再次手术外,均未见复发。结论腹腔镜下造口旁疝修补术如果注意操作要点,可以替代传统修补术。