Laparoscopic repair of a large perineal hernia after laparoscopic abdominoperineal resection: A case report

A 75‐year‐old woman underwent laparoscopic abdominoperineal resection. Four months after abdominoperineal resection, the patient complained of a perineal bulge and urination disorder. Abdominal CT showed protrusion of the small intestine and bladder to the perineum. The patient underwent laparoscopic hernia repair with mesh. The size of the hernial orifice was 7.0 × 9.0 cm, and it had no solid rim. The mesh was tacked ventrally to the pectineal ligament and dorsally to the sacrum, and then sutured on the lateral side. The hernia has not recurred 10 months after the operation. Laparoscopic repair is a good treatment choice for secondary perineal hernia and fixing the mesh to the pectineal ligament, and the sacrum prevents the mesh from sagging.     

Case report of perineal hernia after laparoscopic abdominoperineal resection

Perineal hernia (PH) is a rare complication following laparoscopic abdominoperineal resection (APR) for rectal cancer. We present a case report of perineal hernia after laparoscopic APR and discuss its management. The patient was a 77‐year‐old man who was diagnosed with lower rectal cancer. He underwent laparoscopic APR and bilateral lateral lymph node dissection. Two months after the surgery, pain and bulging in the perineal region developed, and PH was diagnosed by CT. Repair with a polypropylene mesh was performed using a combination of laparoscopic abdominal and transperineal approaches. Reportedly, the incidence of secondary PH after APR has increased along with the rate of laparoscopic surgery. Treatment of secondary PH with transperineal repair alone may cause injuries to other organs because of adhesion of the pelvic viscera. In the present case, we safely repaired the hernia repair using a laparoscopy‐assisted perineal approach.     

A case of successful laparoscopic intraperitoneal onlay mesh plus technique repair for perineal hernia after laparoscopic abdominoperineal resection

The frequency of secondary perineal hernia after abdominoperineal resection has been reported as 0.83%-26%. The optimal surgery for secondary perineal hernia and surgical indication remains controversial. An 87-year-old woman diagnosed with lower rectal cancer underwent laparoscopic abdominoperineal resection. Follow-up computed tomography at 6 months postoperatively revealed secondary perineal hernia. She reported no discomfort and no incarceration was apparent, but she complained of perineal discomfort 3 months later. Laparoscopic repair surgery was performed using an intraperitoneal onlay mesh plus technique with VENTRALIGHT® ST mesh (Medicon, Osaka, Japan), a non-absorbable mesh with a biodegradable coating. No recurrence of peritoneal hernia was seen as of 3 months postoperatively. A time lag can exist between imaging findings and symptom appearance. This laparoscopic intraperitoneal onlay mesh plus technique might become the optimal treatment for perineal hernia.     

Combined laparoscopic abdominoperineal resection and robotic‐assisted prostatectomy for synchronous double cancer of the rectum and the prostate

Here we report a combined laparoscopic abdominoperineal resection and robotic‐assisted prostatectomy. A 74‐year‐old man was diagnosed with T4b low rectal and prostate cancer. The operation was performed after neoadjuvant chemotherapy for the rectal cancer. The procedure used eight ports in total, five for laparoscopic abdominoperineal resection and six for robotic‐assisted prostatectomy. First, laparoscopic total mesorectal excision including division of the inferior mesenteric artery was performed, and then, robotic dissection of the prostate was performed. The en bloc specimen was removed through the perineal wound. Then, robotic urethrovesical anastomosis was performed. An extraperitoneal end colostomy was created to finish the operation. The operating time was 545 min, and blood loss was 170 mL. The postoperative course was uneventful, and the patient discharged on postoperative day 17. The combined laparoscopic abdominoperineal resection and robotic‐assisted prostatectomy were performed safely without any additional technical difficulty, as both procedures shared port settings and patient positions.     

Laparoscopic mesh repair of a Morgagni hernia using the double‐crown technique: A case study

We report a case of Morgagni hernia in which the patient underwent laparoscopic mesh repair. A 65‐year‐old woman presented with an abnormal shadow in the right lower lung field on a routine medical checkup. CT showed that the transverse colon passed between the liver and abdominal wall, and herniated into the thoracic cavity. Simple closure was precluded by the large hernial orifice. We therefore performed laparoscopic repair using a Parietex Optimized Composite Mesh. The double‐crown technique was used to fix the margin of the mesh to the region around the hernial orifice. Our procedure for repair of a Morgagni hernia with a large hernial orifice is safe and minimally invasive, and it may effectively prevent recurrence.     

Laparoscopic repair of Morgagni hernia with composite mesh in an elderly woman: Report of a case

A 78‐year‐old woman was admitted to another hospital with vomiting. Chest X‐ray showed an abnormal shadow in the lower right lung field, and CT indicated a Morgagni hernia containing the stomach and transverse colon. The patient was transferred to our hospital and underwent laparoscopic surgery. After the hernia contents were repositioned into the abdominal cavity, we repaired the hernia orifice with a prosthetic mesh to achieve a tension‐free repair. There were no complications after the surgery, and there has been no recurrence. The patient has remained free of clinical symptoms since 10 months after the surgery. Laparoscopic repair with a prosthetic mesh for Morgagni hernia is a simple and safety procedure for elderly patients.     

Two‐stage laparoscopic curative resection for synchronous multiple colorectal cancers: A case report

A 75‐year‐old man tested positive for occult blood in the stool. A subsequent examination indicated concurrent locally advanced cancer (cT3) at the hepatic flexure and lower rectum cancer in the external anal sphincter. Because of the locally advanced rectal cancer (cT4), preoperative chemoradiotherapy was administered. First, laparoscopic right hemicolectomy and colostomy were performed at the sigmoid colon. Chemoradiotherapy for rectal cancer was initiated on day 18 after the surgeries. Seven weeks after chemoradiotherapy had been completed, laparoscopic abdominoperineal resection and right lateral pelvic lymph node dissection were performed. This case demonstrated that a second radical surgery for rectal cancer could be performed safely and laparoscopically after laparoscopic colectomy and colostomy.     

Successful resection of cellular angiofibroma in the retroperitoneum by using laparoscopic approach

Retroperitoneal cellular angiofibroma (RCA) is very rare, and the optimal treatment for RCA has not been established. We report the case of RCA in a 58‐year‐old man who underwent curative laparoscopy‐assisted resection. Preoperative computed tomography showed heterogeneous enhancement of the 7 cm diameter tumor in the pelvis. A smaller (2.3 cm) mass was also detected in the small intestine. The preoperative diagnosis was peritoneal metastasis of the gastrointestinal tumor of the small intestine. The pelvic tumor was laparoscopically mobilized from the rectum, the left ureter, and the left internal iliac vessels. The tumor was excised by detachment from the urinary bladder in laparotomy. The pathological diagnosis was RCA. The tumor had not recurred by the 1‐year follow‐up. The laparoscopic approach thus might be useful for resection of RCA.     

Two cases of early recurrence after transabdominal preperitoneal inguinal hernia repair

We performed transabdominal preperitoneal inguinal hernia repair in 46 patients (58 diseases), two of whom experienced early recurrence after mesh repair. Case 1 was a 76‐year‐old man with a bilateral inguinal hernia (recurrence site, left indirect hernia) after appendectomy. The recurrence occurred 1 month after transabdominal preperitoneal inguinal hernia repair. The mesh was dislocated to the lateral side, and we repaired it using the direct Kugel ® patch with an anterior technique. Case 2 was a 79‐year‐old man with a bilateral inguinal hernia (recurrence site, right direct hernia with an orifice >3 cm) after appendectomy. The recurrence occurred 3 months after transabdominal preperitoneal inguinal hernia repair. The mesh was dislocated to the lateral side, and we repaired it using an ULTRAPRO ® Plug with an anterior technique under laparoscopic observation. We believe the recurrences resulted from insufficient internal exfoliation and fixation affected by complicated exfoliation of the preperitoneal space with omental adhesion after intraperitoneal surgery.     

Laparoscopic transabdominal preperitoneal hernioplasty for recurrent obturator hernia: A case report

Reports of recurrence after obturator hernia repair are few. We describe the case of an 89‐year‐old woman who presented to us with a thrice recurrent obturator hernia. She had undergone open non‐mesh repair twice and then laparoscopic non‐mesh repair. She was readmitted to our hospital 6 months after the laparoscopic repair. Manual reduction was successful, paving the way for elective transabdominal preperitoneal repair. During the endoscopic repair, surgical mesh was placed extraperitoneally over the hernia defect and then fixed to Cooper's ligament with absorbable tacks. The patient was discharged on postoperative day 2 without complications. In the 2 months that have passed since the surgery there has been no sign of recurrence, but the patient will be carefully followed up. Repair of a recurrent obturator hernia is technically challenging; however, the transabdominal preperitoneal approach seems to be reliable and safe.     

Inguinoscrotal hernia containing the urinary bladder successfully repaired using laparoscopic transabdominal preperitoneal repair technique: A case report

We report herein a patient with an inguinoscrotal hernia containing the urinary bladder. The hernia was safely repaired using the laparoscopic transabdominal preperitoneal repair technique. A 76‐year‐old man was admitted to our hospital with abdominal pain, vomiting, and diarrhea. His scrotum was swollen to fist size. Abdominal CT showed herniation of the sigmoid colon and the bladder into the right inguinal region, and his abdominal pain was attributed to incarceration of the sigmoid colon; this was manually reduced. About 1 month later, we performed transabdominal preperitoneal repair. After the direct hernial orifice was identified, the bladder was noted to be sliding from the medial side of the hernia; this was reduced. Peeling on the medial side was carried out to the middle of the abdominal wall, and the myopectineal orifice was covered with mesh. The patient was discharged on postoperative day 1.     

A case of Spigelian hernia after laparoscopic incisional hernia repair

Laparoscopic ventral hernia repair with intraperitoneal onlay mesh reinforcement is often performed in clinical practice. We herein describe a patient who developed a Spigelian hernia at the edge of the mesh due to rupture of the muscular layer in the abdominal wall. A 69-year-old woman developed a left-sided abdominal bulge 15 months after laparoscopic ventral hernia repair. CT showed a 33-mm defect in the abdominal wall at the lateral edge of the left abdominal rectus muscle with an intestinal prolapse through the defect. She was diagnosed with a Spigelian hernia and underwent operation. The hernia orifice was located at the aponeurosis of the transverse abdominal muscle where the thread had been used to fix the mesh through all layers of the abdominal wall. This report details a case of a Spigelian hernia after laparoscopic ventral hernia repair.     

股薄肌皮瓣修复直肠癌腹会阴切除术后会阴缺损的护理

目的探讨采用带蒂股薄肌肌皮瓣Ⅰ期修复直肠癌腹会阴切除术后会阴部缺损的临床特点,总结手术前后的护理措施。方法对2001年7月～2004年7月在我院行腹会阴切除术后接受了股薄肌肌皮瓣Ⅰ期移植会阴部缺损修复术的7例患者进行护理,观察术后并发症发生及切口愈合情况。结果7例患者术后无切口裂开、切口脓肿或肠梗阻等并发症,术后平均17d会阴部切口Ⅰ期愈合出院,B超会阴部检查均无明显积液。结论采用带蒂股薄肌皮瓣Ⅰ期修复直肠癌腹会阴切除术后会阴部的缺损,效果理想。术后对移植皮瓣以及创面引流的精心护理是减少手术并发症的有效措施。     

Dynamic graciloplasty versus implant of artificial sphincter for continent perineal colostomy after Miles' procedure: Technique and early results

Abdominoperineal resection (APR) is still the standard surgical treatment of anorectal cancers close to the dentate line. Unfortunately, a permanent iliac colostomy is a severe limitation of the quality of life. Attempts to construct a continent perineal colostomy after anorectal excision have been made over the last 15 years with uncertain benefits. We report on our early results of two different procedures consisting of a laparoscopic approach to abdominoperineal rectal excision, fashioning a perineal colostomy with dynamic graciloplasty or implant of an artificial sphincter. Between 2000 and 2004, a total of six patients underwent laparoscopic abdominoperineal resection or reversal of Miles' procedure and construction of perineal colostomy with dynamic graciloplasty (three cases) or implant of an artificial bowel sphincter (three cases). A diverting loop ileostomy was constructed in all patients to prevent contamination. Data concerning the perioperative management, postoperative morbidity and mortality and function after total anorectal reconstruction at the time of discharge, at postoperative month 1 and after ileostomy closure were collected and evaluated in a prospective non-randomised fashion. No early postoperative complications occurred in both groups. No late complication occurred in the dynamic graciloplasty group, whilst one patient of the artificial sphincter group had an ulceration of the tubing and the control pump through the suprapubic skin and the labium skin respectively on postoperative day 35. Another patient in this group, with an erosion of the transposed colon wall, died of myocardial infarction on postoperative day 75 after removal of the prosthesis. Postoperative stay after artificial sphincter implant and dynamic graciloplasty ranged from 12 to 27 days and 16 to 24 days, respectively. The loop ileostomy was closed at postoperative month 3 in all remaining patients except for one in the dynamic graciloplasty group, who died one day before hospitalization for ostomy closure because of an accidental, not disease/operation related reason. Follow-up of patients of the dynamic graciloplasty and artificial sphincter groups ranged from 3 to 24 months and 2.5 to 9.5 months, respectively. Patients in the dynamic graciloplasty group had no complications and follow-up showed satisfactory continence (SF36 form). All patients in the artificial sphincter group had late local complications with erosion of the prosthesis through the wall, its consequent removal and construction of a permanent iliac colostomy. Laparoscopic APR has been reported to be as safe as open APR. There are no published, available data on laparoscopic APR and laparoscopic reversal of Miles' procedure with total anorectal reconstruction with either dynamic graciloplasty or implant of artificial sphincter. Preliminary results showed that laparoscopic APR and APR reversal with continent perineal colostomy and dynamic graciloplasty may be a possible option in selected patients whilst the implant of an artificial sphincter should not be considered as a safe surgical option in such patients.     

Scar endometriosis developing after an umbilical hernia repair with mesh

A 44-year-old female was initially evaluated for a 3-cm umbilical hernia, which developed after a laparoscopic myomectomy performed seven years prior. The umbilical hernia was repaired using a synthetic mesh. Eight months after the umbilical hernia repair, the patient returned with chronic pain in a 3-cm raised mass originating from the umbilical hernia repair incision. The mass and mesh were surgically removed. The umbilical fascial defect was repaired with a primary fascia-to-fascia closure and the umbilicus was reconstructed from adjacent skin. The mass was found histologically to be endometriosis and fascial scarring with a foreign body reaction to synthetic mesh. Umbilical endometriosis developed either from peritoneal endometrial seeding from a laparoscopic myomectomy or from metaplasia of multipotential cells, which developed into endometriosis due to inflammatory stimulation by the synthetic mesh. Synthetic mesh probably should be avoided in the surgical repair of a laparoscopically caused umbilical hernia in a premenopausal female especially if there is a history of pelvic endometriosis.     

Robot-assisted laparoscopic abdominoperineal resection for anal canal cancer associated with Crohn's disease: A case report

A 37-year-old man with Crohn's disease (CD) and a history of abdominal surgery was diagnosed with anal canal cancer. Robot-assisted laparoscopic abdominoperineal resection was performed and the patient was discharged without any postoperative complications. Recently, minimally invasive surgery for CD patients has grown in popularity. However, there have been few studies of robotic surgery for CD patients with anal canal cancer. To the best of our knowledge, we present the first report of a patient with CD-associated anal canal cancer who underwent robot-assisted laparoscopic abdominoperineal resection.     

腹腔镜肾盂癌根治术19例分析

目的评价腹腔镜肾孟癌根治术并总结经验。方法2000年8月＂2006年5月行腹腔镜手术治疗19例肾孟癌（含8例手辅式）。其中输尿管末端经尿道切除17例，经手辅切口切除2例。同时期行开放性肾孟癌根治术30例作对照分析。结果腔镜组与开放组手术时间差异无显著（P=0．59），腔镜组术中出血量、术后肠功能恢复时间、引流管拔除时间、下床活动时间及住院时间显著少于开放组（P〈0．01），腔镜组术中、术后未发生明显并发症。开放组1例出现术后切口感染。随访1～61个月，腔镜组1例肺部转移，开放组1例出现肺部转移，1例腹膜后局部复发，1例发生膀胱癌。结论后腹腔镜结合电切镜行肾孟癌根治术具有创伤小、恢复快的优点。并不增加肿瘤种植的风险，有望取代传统开放手术。     

Laparoscopic mesh repair for lumbar hernia after iliac crest bone harvest

Lumbar hernia after iliac crest bone harvest is relatively rare. When it does occur, it presents as a flank abdominal protrusion through a lateroposterior abdominal wall defect. A laparoscopic approach for this type of hernia is reported to have advantages over the classic open method. Here, we present a case of a 49‐year‐old Caucasian man who presented with an enlarged left flank mass after iliac bone harvest for pseudarthrosis. He had undergone open onlay mesh repair for inferior lumbar hernia, but the hernia recurred 3 months postoperatively. Laparoscopic intraperitoneal onlay mesh repair using a composite mesh was performed 7 months after recurrence. The patient was discharged 6 days postoperatively without complications. No signs of recurrence were detected during 1‐year follow‐up period. The laparoscopic approach for lumbar hernia conferred excellent visualization of the hernia defect and enabled a safe mesh repair using intra‐abdominal pressure to hold it in position. This approach provided all the benefits of minimally invasive surgery.     

应用脐旁皮瓣修复会阴部烧伤瘢痕挛缩畸形临床效果观察

目的探讨应用脐旁皮瓣修复会阴部烧伤瘢痕畸形的临床效果。方法 2003年3月至2011年1月我院整形外科收治会阴部烧伤瘢痕畸形患者32例。术中完全松解及切除会阴部瘢痕组织,使尿道口、阴道口及肛门恢复到解剖位置。肛门严重狭窄者,需彻底切除肛门周围及肛管的瘢痕组织,完全解除狭窄,使肛门口充分开放,将形成的脐旁皮瓣行明道转移至会阴部。在皮瓣中间对应尿道外口及肛门位置切开形成尿道及肛门外口,肛门外口与直肠黏膜缝合,将皮瓣缝合于会阴创面。结果 32例患者中3例出现皮瓣远端发绀,经检查发现2例皮瓣下积血,1例因缝合张力过大引起。清除血肿及拆除部分缝线后皮瓣远端循环得到改善,皮瓣完全存活,经延迟拆除缝线后伤口愈合。1例出现皮瓣感染,导致远端部分坏死,后通过植皮进行创面修复。术后随访0.5～1年,术后皮肤质地、会阴外形功能及生殖器位置均良好;双髋活动度除2例因缺乏功能锻炼及皮瓣皮片后期挛缩恢复不理想外,其余双髋活动度良好。结论脐旁皮瓣不受会阴瘢痕限制,组织相似度好,血管恒定,抗感染能力强,是修复会阴部瘢痕畸形的理想皮瓣。     

Case of idiopathic and complete appendiceal intussusception

Appendiceal intussusception is a rare disease in which the appendix invaginates into the cecum. It is often caused by organic diseases. The present case involved an appendiceal intussusception without an organic disease, and laparoscopic resection of part of the cecum was performed. Appendiceal intussusception has various causes, including malignant diseases. Therefore, diagnosis and selection of operative method are complex and could potentially lead to an excessively invasive option. By performing SILS with a multiuse single‐site port, we were able to provide an appropriate, non‐invasive treatment that had a good esthetic outcome.