Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, Osaka, Japan.
Department of Surgical Oncology, Osaka City University Graduate School of Medicine, Osaka, Japan.
J Obstet Gynaecol Res. 2022 Feb;48(2):510-514. doi: 10.1111/jog.15098. Epub 2021 Nov 21.
Perineal hernia is an infrequent complication of abdominoperineal resection (APR) and, currently, there is no consensus as to the optimal operative technique. Surgical repair can be achieved by either cerclage or the use of mesh or autologous tissue, and it has been reported that the recurrence rate after repair using autologous tissue is 33%. We present two post-APR cases of severe perineal hernia with pelvic organ prolapse (POP) which did not improve after repair using mesh. We regenerated the pelvic floor using a vertical rectus abdominis myocutaneous (VRAM) flap and performed a concomitant sacrocolpopexy to fix the POP. Drooping of the perineum and pelvic floor was greatly improved, and the patients have not experienced any recurrence for 6 years. This dual procedure has not been previously mentioned in the literature, and we consider this the first report of its kind.
会阴疝是经腹会阴切除术（APR）的罕见并发症，目前对于最佳手术技术尚无共识。会阴疝的手术修复方法可以采用环扎术或使用网片或自体组织，据报道，使用自体组织修复后的复发率为 33%。我们报告了 2 例 APR 后严重会阴疝合并盆腔器官脱垂（POP）的病例，这些病例在使用网片修复后没有改善。我们使用垂直腹直肌肌皮瓣（VRAM）来重建盆底，并同时进行骶骨阴道固定术以固定 POP。会阴和盆底下垂得到了很大改善，患者 6 年来未出现任何复发。这种双重手术在文献中尚未提及，我们认为这是首例报道。
