ObjectiveTo investigate the effectiveness of repair procedure using biological mesh with Onlay-Reinforce technique in patients with perineal hernia. MethodsBetween January 2005 and December 2012, 9 patients with perineal hernia after laparoscopic abdominoperineal resection for rectal cancer (Miles operation) were treated. There were 3males and 6 females with a mean age of 70 years (range, 61-78 years). The disease duration was 1-9 months (mean, 4.5 months). The most beginning symptom was distending pain in perineal region, and then reducible mass was found without bowel incarceration. All patients underwent hernia repair using biological mesh with Onlay-Reinforce technique through original perineal incision. ResultsThe hernial size was 9.8-20.5 cm2 (mean, 16.0 cm2); the size of biological mesh was 58-80 cm2 (mean, 70.2 cm2); and the intraoperative blood loss was 10-80 mL (mean, 50.5 mL). All of the patients underwent repair operation successfully. The operation time was 45-90 minutes (mean, 60.6 minutes); and the hospitalization time was 4-7 days (mean, 5.9 days). One patient had urine retention, which was relieved after 7 days indwelling catheter. All the wounds healed by first intention without infection. The patients were followed up 14.5-60.7 months (mean, 37.8months). No chronic pain, obvious foreign body sensation, or hernia recurrence developed. ConclusionUse of biological mesh with Onlay-Reinforce technique for the repair of perineal hernia after Miles operation is safe and effective.
ObjectiveTo explore necessity, safety, and clinical significance of pelvic floor reconstruction following laparoscopic abdominoperineal resection for low rectal cancer. MethodsThirty-seven patients with low rectal cancer admitted to our hospital from July 2013 to January 2016 were collected, who were divided into reconstruction group and non-reconstruction group according to the pelvic floor reconstruction or not. The complications were compared in two groups. ResultsThe laparoscopic abdominoperineal resections were successfully completed in all the patients with low rectal cancer, there was no case of conversion to open surgery. The operative time was (173.6±18.3) min, the suture time of pelvic floor peritoneal was (28.6±7.5) min. The postoperative following-up was 3-24 month. There were 5 cases (22.7%) of complications in the non-reconstruction group, included 2 cases of adhesive intestinal obstruction, 1 case of perineal incision hernia, 1 case of pelvic effusion and infection, 1 case of radiation enteritis caused by radiotherapy. There was 1 case (6.7%) of adhesive intestinal obstruction in the reconstruction group. Although the incidence of postoperative complications in the reconstruction group was lower than that in the non-reconstruction group, there was no significant difference between these two groups (χ2=2.367, P=0.096 1). ConclusionThe preliminary results of limited cases in this study show that it is not essential for pelvic floor reconstruction following laparoscopic abdominoperineal resection for rectal cancer, but it could obviously decrease difficulty of operation for postoperative reoperation, especially for postoperative radiotherapy patients, and prevent occurrence of radiation enteritis. It is still necessary because it is more consistent with principle of open surgery, Hem-o-lok 3-0 Angiotech Quilltm clip or barbed suture closure of pelvic peritoneum, it is technically safe and feasible.