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Tissue expanders: early experience of a novel treatment option for perineal herniation

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Abstract

Purpose

Acquired perineal hernias through the reconstructed pelvic floor can complicate radical pelvic operations including abdominoperineal resection of rectum. Operative intervention is indicated for symptomatic hernias. There is a lack of consensus as to the best operative technique. Here we present a novel method for repairing perineal herniation using saline-filled tissue expanders.

Methods

Perineal hernia repair may be affected either via an abdominal or via a perineal approach. After adhesiolysis to remove small bowel from the pelvis, a Natrelle™ 150SH tissue expander (Allergan Inc., California, USA) or Siltex™ Round Becker (Mentor Medical Systems, Holland) of appropriate size is inserted in the pelvis and the button placed in a subcutaneous pocket in the perineal skin. The tissue expander is then filled with saline until it fills the true anatomical pelvis without bladder compression. The volume may be increased or decreased postoperatively by accessing the subcutaneous button.

Results

We have performed this procedure in three patients with some success, all of whom have experienced symptomatic relief. The tissue expander may subsequently be removed without recurrence of symptoms, due to the fibrous capsule which forms. One patient required re-operation to elevate a herniating tissue expander. The tissue expander was removed earlier than anticipated to avoid deep pelvic infection in another.

Conclusion

Our early experience suggests that using saline-filled tissue expanders to fill dead space in the pelvis after radical surgery may prove to be a valuable approach to perineal herniation, particularly if adjuvant radiotherapy is planned.

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References

  1. Moschcowitz AV (1916) Perineal hernia. Surg Gynecol Obstet 26:514–520

    Google Scholar 

  2. Yeoman FC (1939) Hernia, perineal and pudendal. Am J Surg 43:695–697

    Article  Google Scholar 

  3. So JB, Palmer MT, Shellito PC (1997) Postoperative perineal hernia. Dis Colon Rectum 40:954–957

    Article  PubMed  CAS  Google Scholar 

  4. Alaa SO, Jabbar A (2002) Postoperative perineal hernia. Hernia 6:188–190

    Article  Google Scholar 

  5. Beck DE, Fazio VW, Jagelman DG, Lavery IC, McGonagle BA (1987) Postoperative perineal hernia. Dis Colon Rectum 30:21–24

    Article  PubMed  CAS  Google Scholar 

  6. Hullsiek HE (1956) Perineal hernia after abdominoperineal resection. Am J Surg 92:735–738

    Article  PubMed  CAS  Google Scholar 

  7. Rutledge RN, Smith JP, Wharton JT, O’Ouinn AG (1977) Pelvic exenteration: an analysis of 296 patients. Am J Obstet Gynecol 129:881–892

    PubMed  CAS  Google Scholar 

  8. Aboian E, Winter DC, Metcalf DR, Wolff BG (2006) Perineal hernia after proctectomy: prevalence, risks and management. Dis Colon Rectum 49:1564–1568

    Article  PubMed  CAS  Google Scholar 

  9. Skipworth RJ, Smith GH, Anderson DN (2007) Secondary perineal hernia following open abdominoperineal excision of the rectum: report of a case and review of the literature. Hernia 11:541–545

    Article  PubMed  CAS  Google Scholar 

  10. Sarr MG, Stewart JR, Cameron JC (1982) Combined abdominoperineal approach to repair of postoperative perineal hernia. Dis Colon Rectum 25:597–599

    Article  PubMed  CAS  Google Scholar 

  11. Stamatiou D, Skandalakis JE, Skandalakis LJ, Mirilas P (2010) Perineal hernia: surgical anatomy, embryology, and technique of repair. Am Surg 76:474–479

    PubMed  Google Scholar 

  12. Cawkwell I (1963) Perineal hernia complicating abdominoperineal resection of the rectum. Br J Surg 50:431–433

    Article  PubMed  CAS  Google Scholar 

  13. Ego-Aguirre E, Spratt JS, Butcher HR, Bricker EM (1964) Repair of perineal hernia developing subsequent to pelvic exenteration. Ann Surg 159:66–71

    Article  PubMed  CAS  Google Scholar 

  14. Delmore JE, Turner DA, Gershenson DM, Horbelt DV (1987) Perineal hernia repair using human dura. Obstet Gynecol 70(3):507–508

    PubMed  CAS  Google Scholar 

  15. Bach-Nielson P (1967) New surgical method of repairing sacral hernia following abdominoperineal excision of the rectum. Acta Chir Scand 133:67–68

    Google Scholar 

  16. Kelly AR (1960) Surgical repair of post-operative perineal hernia. Aust N Z J Surg 29:243–245

    Article  PubMed  CAS  Google Scholar 

  17. Bell JG, Weiser EB, Metz P, Hoskins WJ (1980) Gracilis muscle repair of perineal hernia following pelvic exenteration. Obstet Gynecol 56:377–380

    PubMed  CAS  Google Scholar 

  18. Leuchter RS, Lagasse LD, Hacker NF, Berek JS (1982) Management of post-exenteration perineal Hernias by myocutaneous axil flaps. Gynecol Oncol 14:15–22

    Article  PubMed  CAS  Google Scholar 

  19. Hurwitz DJ, Walton RL (1982) Closure of chronic wounds of the perineal and sacral regions using the gluteal thigh flap. Ann Plast Surg 8:375–386

    Article  PubMed  CAS  Google Scholar 

  20. Erdmann MW, Waterhouse N (1995) The transpelvic rectus abdominis flap: its use in the reconstruction of extensive perineal defects. Ann R Coll Surg Engl 77:229–232

    PubMed  CAS  Google Scholar 

  21. Wille-Jørgensen P, Pilsgaard B, Møller P (2009) Reconstruction of the pelvic floor with a biological mesh after abdominoperineal excision for rectal cancer. Int J Colorectal Dis 24:323–325

    Article  PubMed  Google Scholar 

  22. Hoffman JP, Lanciano R, Carp NZ, Merrick MA, Rosenblum MG, Hogan WM, Sigurdson ER, Litwin S, Eisenberg BL (1994) Morbidity after insertion of saline-filled tissue expanders for small bowel exclusion from radiotherapy treatment fields. Am Surg 80:173–183

    Google Scholar 

  23. O’Duffy F, Toomey DP, Fleming F, McNamara DA (2011) Novel use of an air filled breast prosthesis to allow radiotherapy to recurrent colonic cancer. Colorectal Dis 13:e42–e45

    Article  PubMed  Google Scholar 

  24. West NP, Anderin C, Smith KJ, Holm T, Quirke P, European Extralevator Abdominoperineal Excision Study Group (2010) Multicentre experience with extralevator abdominoperineal excision for low rectal cancer. Br J Surg 97:588–599

    Article  PubMed  CAS  Google Scholar 

  25. Kidmose Christensen H, Nerstrøm P, Tei T, Laurberg S (2011) Perineal repair after extralevator abdominoperineal excision for low rectal cancer. Dis Colon Rectum 54:711–717

    Article  Google Scholar 

  26. Whitfield GA, Horan G, Irwin MS, Malata CM, Wishart GC, Wilson CB (2009) Incidence of severe capsular contracture following implant-based immediate breast reconstruction with or without postoperative chest wall radiotherapy using 40 gray in 15 fractions. Radiother Oncol 90:141–147

    Article  PubMed  Google Scholar 

  27. Geller MA, Argenta PA, Thomas SG, Dusenbery KE, Jusdon PL, Boente MP (2009) Feasibility and morbidity of using saline filled tissue expanders to reduce radiation-induced bowel injury in patients with gynaecologic malignancies. Eur J Obstet Gynecol Reprod Biol 143:93–97

    Article  PubMed  Google Scholar 

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Cambridge Colorectal Unit, BOX 201, Cambridge University Hospital, Hills Road, Cambridge, CB2 0QQ, UK

    J. M. Ali, A. Stabler, N. R. Hall, R. Miller & N. S. Fearnhead

  2. Department of Plastic and Reconstructive Surgery, Cambridge University Hospital, Hills Road, Cambridge, CB2 0QQ, UK

    M. Irwin

Authors
  1. J. M. Ali
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  2. A. Stabler
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  3. N. R. Hall
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  4. M. Irwin
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  5. R. Miller
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  6. N. S. Fearnhead
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Correspondence to J. M. Ali.

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Ali, J.M., Stabler, A., Hall, N.R. et al. Tissue expanders: early experience of a novel treatment option for perineal herniation. Hernia 17, 545–549 (2013). https://doi.org/10.1007/s10029-012-0939-9

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  • DOI: https://doi.org/10.1007/s10029-012-0939-9

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