Introduction Previously, perineal herniation following abdominoperineal excision (APE) has been considered a rare complication affecting <1% of cases,however, this rate is likely to increase with extra levator APE approach and lower mortality due to improved management of rectal cancer. This case series of patients aims to investigate whether a larger pelvic outlet is associated with development of perineal hernias. Secondary aims include investigating the association of gender and chemoradiotherapy with perineal herniation.
Method Retrospective data on patients who underwent APE between May 2006 and October 2014 in a single UK institution were collected. Analysis of Magnetic Resonance Imaging (MRI) and Computerised Tomography (CT) scans determined pelvic cavity dimensions and the presence of perineal herniation. Perineal hernias were defined as a defect containing bowel, uterus, bladder, vagina or omentum dropping below the pubococcygeal line. Consequently asymptomatic perineal hernias were included in this data. Perineal defects resolving naturally over time were not considered to be a hernia. Pelvic floor descent was measured from the pubococcygeal line to the lowest point of the descended material or matter. Data for gender and treatment with chemoradiotherapy (CRT) were extracted from patient notes. Data were tested for normality and appropriate t-tests used.
Results Post-operative data were available for 63/73 patients, mean age 67 years (range 26–85), of which 67% were male. First postoperative scans presented 17/63 (27%) patients with a perineal hernia. Most recent scans showed 23/63 (37%) patients with a perineal hernia. No significant difference was found between post-operative pelvic outlet size and presence of a perineal hernia (9.8 v 10.3, P < 0.2). No significant difference was found in the preoperative size of the pelvic outlet between females and males (9.2cm vs. 9.1cm, P < 0.78). CRT was not associated with an increased risk of perineal herniation or increased pelvic floor descent.
Conclusion Our data suggest that the size of the pelvic outlet and gender could be less important than previously thought in development of a perineal hernia. It could be suggested that patients at risk of perineal herniation present early after surgery and that increased survival time does not necessarily increase the risk of developing a perineal hernia. This may be due to improved surgical technique and closure with porcine mesh.
Disclosure of interest None Declared.
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