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Perineal Hernia Repair Using Permanent Suture and Mesh
IUGA Academy. Avondstondt A. Jun 30, 2018; 213243; 143
Dr. Andrea Avondstondt
Dr. Andrea Avondstondt

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143

Perineal hernia repair using permanent suture and Mesh

Avondstondt, A1; Salamon, C1; Ezzedine, D2

1: Atlantic Health System; 2: Maimonides Medical Center

Introduction: A perineal hernia is the uncommon, abnormal protrusion of intra-abdominal structures, such as the small bowel or colon, through a defect in the levator plate into the perineal area. Asymptomatic patients with perineal hernias may choose observation but symptomatic patients typically require surgical intervention. Due to the rarity of this condition, the ideal surgical approach to perineal hernia repair has not been established with successful abdominal, transperineal, or combined routes reported.

Objective: We present the case of a posterior perineal hernia repaired robotically using permanent sutures and mesh. A concomitant supracervical hysterectomy and colpopexy was performed.

Methods: This video presentation reports a 67-year-old woman presenting to our office with worsening bulge symptoms. Her history was remarkable for 4 vaginal deliveries, 1 cesarean section, and posterior repair 14 years prior. On examination, a large left-sided perineal hernia containing small bowel was found in addition to stage 3 uterovaginal prolapse. A minimally invasive robotic-assisted abdominal approach was chosen for repair. Upon entry into the abdominal cavity, a 4 cm left-sided levator defect was noted with a 6 cm hernia sack in contact with perineal skin. The small bowel content was easily reduced, the hernia sack excised and the defect closed with permanent polytetrafluoroethylene suture. The posterior arm of the sacrocolpopexy mesh was used to reinforce the hernia repair. A supracervical hysterectomy and sacrocolpopexy were performed concomitantly to treat the uterovaginal prolapse.

Results: At 14 month follow up, the patient was doing well and symptom-free. Robotic-assisted surgical repair of this perineal hernia offered excellent intra-operative visualization and complete delineation of the defect with clear visualization of surrounding pelvic structures.

Conclusions: Perineal hernias are a rare cause of pelvic bulge symptoms in women. In the appropriate candidate, robotic-assisted abdominal approach including excision of the hernia sac and defect closure using permanent suture with mesh offers patients a safe and effective method for perineal hernia repair. Increased reporting in urogynecology literature may help guide optimal treatment for practitioners.

Disclosure:

Work supported by industry: no. A consultant, employee (part time or full time) or shareholder is among the authors (Boston scientific consultant; Intuitive surgical, Inc. consultant).

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