LAUSR

BACKGROUND Perineal hernia is a well-known, rare complication following abdominoperineal resection for rectal cancer. Due to its rarity, the literature on its surgical repair is comprised of case reports and small case series, and not one surgical approach has been established as superior. OBJECTIVE The current study aimed to identify the repair methods used at our institution, and their outcomes. We hypothesized that a perineal approach would have a similar recurrence rate to a transabdominal repair, with shorter hospital length of stay. DESIGN This is a retrospective case series. SETTINGS A large single-institution was the setting. PATIENTS Patients who underwent surgical repair for perineal hernia from January 2009 to December 2019 were included in the review. MAIN OUTCOME MEASURES The primary outcomes were perineal hernia recurrence, surgical approach to repair, length of stay. RESULTS We identified 36 patients who underwent surgical repair of perineal hernia at our institution. The majority of patients received neoadjuvant chemoradiation therapy (n=20). Most patients (n=29) had previously undergone abdominoperineal resection (n=5 robotic, n=15 laparoscopic, n=1 robotic converted to open, n=8 open). Patients were repaired through a perineal approach (n=22) or transabdominally (n=14). The median length of stay was 4 days (range, 1-12) after a perineal approach and 8 days (range 3-18) after a transabdominal approach. At a median follow-up of 12.7 months (range, 1-72) there were 4 recurrences after perineal repair and 3 recurrences after transabdominal. LIMITATIONS Small sample size (n=36), retrospective and non-randomized nature of the case series, lack of routine postoperative imaging, median follow-up length of 12.7 months may not be adequate to detect all recurrences. CONCLUSIONS This case series supports the perineal approach for surgical repair; it should be the first approach considered as it is less invasive and may be associated with shorter length of stay compared to an open transabdominal approach. Male gender and neoadjuvant chemotherapy may be possible risk factors for the development of perineal hernia after abdominoperineal resection. See Video Abstract at http://links.lww.com/DCR/B856.