Department of Surgery, Pietermaritzburg Hospital Complex, University of KwaZulu Natal, Durban, South Africa.
Colorectal Dis. 2012 Jul;14(7):e400-6. doi: 10.1111/j.1463-1318.2012.02970.x.
The purpose of this study was to determine treatment characteristics and clinical outcome for patients with perineal hernia after abdominoperineal excision (APE).
A systematic search of the literature revealed 40 individually documented patients, published between 1944 and 2010. Three additional patients treated at our centre were added. Patient characteristics, type of repair and outcome were entered into a database and a pooled analysis of these 43 patients was performed.
The pooled analysis revealed a median time interval of 8 months between APE and surgical repair of perineal hernia. The surgical approaches were perineal in 22 patients, open abdominal in 11, open abdominoperineal in three, laparoscopic in five and laparoscopic-perineal in two patients. A primary recurrence was documented in 13 patients and a second recurrence in three. The recurrence rate was 5/25 for synthetic or biological mesh, 6/12 for primary closure and 2/6 for the remaining techniques. Recurrent perineal hernia was repaired using a synthetic or biological mesh (n = 6), primary closure (n = 5) or a muscle flap (gluteus or gracilis; n = 4).
From these limited and biased data based on published case descriptions, it appears that the recurrence rate of primary perineal hernia repair after APE is lower with the use of a mesh or other assisted closure than with primary suture repair.
本研究旨在确定经腹会阴切除（APE）后会阴疝患者的治疗特征和临床转归。
系统检索文献，共发现 40 例单独记录的患者，发表时间为 1944 年至 2010 年。此外，还增加了我们中心治疗的另外 3 例患者。将患者特征、修复类型和结果录入数据库，并对这 43 例患者进行汇总分析。
汇总分析显示，APE 与会阴疝手术修复之间的中位时间间隔为 8 个月。手术入路包括 22 例经会阴、11 例经开放性腹部、3 例经开放性经腹会阴、5 例经腹腔镜和 2 例经腹腔镜-会阴。13 例患者记录有原发性复发，3 例患者有第二次复发。复发率为 5/25 例合成或生物网、6/12 例初次缝合、6/6 例其余技术。采用合成或生物网（n=6）、初次缝合（n=5）或肌肉瓣（臀大肌或股薄肌；n=4）修复复发性会阴疝。
根据发表的病例描述得出的这些有限且有偏见的数据表明，与初次缝合修复相比，在 APE 后行会阴疝修复时使用网片或其他辅助闭合的方法，其原发性会阴疝的复发率更低。
