Laparoscopic treatment of perineal hernia after previous abdominal perineal rectal resection due to cancer. Case report

The aim of this study is to present a case of laparoscopic treatment of perineal hernia in a patient after abdominoperineal resection od the rectum. We present the case of a 63-year-old woman who was operated on laparoscopically with a mesh sewn in at the level of the sacrum, iliac vessels and pubic symphysis. And covered with a peritoneal flap above the urinary bladder. A 63-year-old woman 4 years earlier underwent neoadjuvant treatment and laparoscopic abdominoperineal resection. The postoperative period was uncomplicated. Histological examination after operation was: adenocarcinoma ypT3N1aM0. The perineal wound healed without complication. 2 years after the above-mentioned surgery, the patient began to experience abdominal pain, especially when sitting down, and symptoms related to "sitting on a pillow". Physical examination revealed a palpable bulge in the perineal wound. The tomographic examination revealed intestinal loops in the perineum and the presence of fatty tissue without any signs of cancer recurrence. 10 cm in diameter mash was sewn at the level of the sacrum, iliac vessels and pubic symphysis. The abdominal symptoms disappeared completely, the so-called perineum cushion was entirely reduced. Laparoscopic treatment of perineal hernia may be a beneficial method for patients, but a demanding method for surgeons mainly due to the proximity of the iliac vessels.