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Session: ePoster: Colon, Colorectal and Rectal Cancer (Sun225)

EP516 - Recurrent Perineal Hernia Repair Utilizing Autologous Tissue Flap

Sunday, May 11, 2025
2:52 PM – 2:57 PM PT
Location: Monitor 7, Sails Pavilion, Upper Level

    ePoster Presenter(s)

  • Talal M. Dahab, MD

    General surgery Resident
    Mayo Clinic Florida
    Jacksonville, FL, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • KH

    Kevin Hancock, M.D.

    Colorectal Surgeon
    Colon & Rectal Associates
    Jacksonville, Florida, United States

    Disclosure information not submitted.

  • OH

    Olivia Ho, MD MMSc MPH FRCSC FACS

    Assistant Professor
    Mayo Clinic
    Jacksonville, Florida, United States

    Disclosure information not submitted.

    • Senior Author(s)

  • MD

    Michelle F. DeLeon, MD

    Consultant
    Mayo Clinic
    Jacksonville, Florida, United States

    Disclosure information not submitted.

All of the relevant financial relationships listed below have been mitigated.
Talal M. Dahab, MD: This individual has no financial relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: Background: Perineal hernia is a rare complication of abdominal perineal resection (APR). There are multiple options for repair including mesh or tissue repairs through perineal or abdominal approaches. We present a unique way to utilize a vertical rectus abdominis musculocutaneous (VRAM) flap for a redo perineal hernia repair after failed mesh repair complicated by infection.

Methods/Interventions: Intervention: 72-year-old female with history of rectal adenocarcinoma treated with Abdominal Perineal resection (APR) that presented with perineal drainage after recurrence of a perineal hernia. Her rectal cancer was treated at outside institution with laparoscopic APR fifteen months prior. Her final pathology was T3N0. She did not receive any chemotherapy or radiation therapy. She developed a perineal hernia five months after APR and underwent laparoscopic perineal hernia repair with 10cmx15cm Gore-Tex mesh.
She presented to our institution six months after the repair with perineal drainage and wound dehiscence for several weeks, already on oral antibiotics. MRI of her pelvis showed herniated small bowel and displaced previous mesh repair. It also showed an abscess in her perineal hernia sac, that was actively draining through her perineal wound. There was no evidence of recurrent cancer. She was treated with antibiotics and was taken for surgery after resolution of her perineal abscess. She underwent exploratory laparotomy, mesh explantation and perineal hernia repair using pedicled vertical rectus abdominis muscle (VRAM) flap reconstruction.

Results/Outcomes: Outcome: Her post operative recovery was complicated by small bowel obstruction from a parastomal hernia requiring complex abdominal wall repair with mesh. She had no complications from the perineal hernia repair. At follow up 6 months later, her wound was healed with no evidence of perineal hernia recurrence.

Conclusion/Discussion:

Conclusion: Perineal hernia after APR is a rare complication, and repair can be challenging and lead to recurrence. In the event of mesh infections or recurrence, a VRAM flap as detailed is an effective option for repair.