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Surgical technique for primary perineal hernia repair: a systematic scoping review

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Abstract

Purpose

A perineal hernia is a subtype of pelvic floor hernias, and especially primary perineal hernias are rare. No guideline exists on how to handle this type of hernia. Therefore, the primary aim of this scoping review was to investigate the surgical treatment options in adults for primary perineal hernias.

Methods

This systematic scoping review included studies with original data on at least one adult operated for a primary perineal hernia. Studies from 1990 and forward were included to cover contemporary surgical techniques. Three databases were systematically searched: PubMed, Embase, and Cochrane CENTRAL. Furthermore, a snowball search was performed. The primary outcome was to narratively present details about the surgical techniques. The secondary outcomes were to give an overview of symptoms, diagnostics, intraoperative complications, and postoperative course.

Results

Twenty-two case studies reported repairs on 22 patients suffering from primary perineal hernia. Common symptoms were pain and discomfort, and a bulge was often found during physical examination. Different diagnostic methods were used, and MRI-scans most often found an abnormality. Different surgical procedures can repair the condition, however, laparotomy and the use of a permanent mesh was the most common option. Far from all studies reported on outcomes, but no severe intraoperative event was reported, and the postoperative course was overall uneventful.

Conclusion

Primary perineal hernia is a very rare condition presenting with pain/discomfort and bulging and it can be visualized with different imaging modalities. Laparotomy with a permanent mesh was often used for repair, and the postoperative course was mostly uneventful.

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Data availability

Data are available from the corresponding author.

References

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

    Article  PubMed  Google Scholar 

  2. Thomford NR, Sherman NJ (1969) Primary perineal hernia. Dis Colon Rectum 12:441–443. https://doi.org/10.1007/BF02617730

    Article  CAS  PubMed  Google Scholar 

  3. Dorland WAN (2012) Dorland's illustrated medical dictionary. Philadelphia

  4. Aptukar DK, Dandekar NK, Jorwekar GK et al (2013) A rare case of internal hernia through a rent in pouch of douglas, six years after abdominal hysterectomy. IJBAR 4:258–260. https://doi.org/10.7439/ijbar.v4i4.332

    Article  Google Scholar 

  5. Watanobe I, Miyano S, Machida M et al (2020) Primary anterior perineal hernia: a case report and review of the literature. Asian J Endosc Surg 13:600–604. https://doi.org/10.1111/ases.12800

    Article  PubMed  PubMed Central  Google Scholar 

  6. Cali RL, Pitsch RM, Blatchford GJ et al (1992) Rare pelvic floor hernias. Report of a case and review of the literature. Dis Colon Rectum 35:604–612. https://doi.org/10.1007/BF02050544

    Article  CAS  PubMed  Google Scholar 

  7. So JB, Palmer MT, Shellito PC (1997) Postoperative perineal hernia. Dis Colon Rectum 40:954–957. https://doi.org/10.1007/BF02051204

    Article  CAS  PubMed  Google Scholar 

  8. Berman L, Aversa J, Abir F et al (2005) Management of disorders of the posterior pelvic floor. Yale J Biol Med 78:211–221

    PubMed  PubMed Central  Google Scholar 

  9. de Campos FG, Habr-Gama A, Araújo SE et al (2005) Incidence and management of perineal hernia after laparoscopic proctectomy. Surg Laparosc Endosc Percutan Tech 15:366–370. https://doi.org/10.1097/01.sle.0000191592.93326.63

    Article  PubMed  Google Scholar 

  10. Habr-Gama A, São Julião GP, Mattacheo A et al (2014) Extralevator abdominal perineal excision versus standard abdominal perineal excision: impact on quality of the resected specimen and postoperative morbidity. World J Surg 41:2160–2167. https://doi.org/10.1007/s00268-017-3963-1

    Article  Google Scholar 

  11. Sayers AE, Patel RK, Hunter IA (2015) Perineal hernia formation following extralevator abdominoperineal excision. Colorectal Dis 17:351–355. https://doi.org/10.1111/codi.12843

    Article  CAS  PubMed  Google Scholar 

  12. Musters GD, Lapid O, Stoker J et al (2016) Is there a place for a biological mesh in perineal hernia repair? Hernia 20:747–754. https://doi.org/10.1007/s10029-016-1504-8

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Merchav R, Feuermann Y, Shamay A et al (2005) Expression of relaxin receptor LRG7, canine relaxin, and relaxin-like factor in the pelvic diaphragm musculature of dogs with and without perineal hernia. Vet Surg 34:476–481. https://doi.org/10.1111/j.1532-950X.2005.00072.x

    Article  PubMed  Google Scholar 

  14. Niebauer GW, Shibly S, Seltenhammer M et al (2005) Relaxin of prostatic origin might be linked to perineal hernia formation in dogs. Ann N Y Acad Sci 1041:415–422. https://doi.org/10.1196/annals.1282.062

    Article  CAS  PubMed  Google Scholar 

  15. Skipworth RJE, Smith GHM, 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. https://doi.org/10.1007/s10029-007-0234-3

    Article  CAS  PubMed  Google Scholar 

  16. Padilla-Longoria R, Martinez-Munive A, Quijano-Orvananos F et al (1999) Tension free perineal hernioplasty: report of a case. Hernia 3:221–223. https://doi.org/10.1007/BF01194431

    Article  Google Scholar 

  17. Tricco AC, Lillie E, Zarin W, O’Brien KK et al (2018) PRISMA extension for Scoping Reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med 169:467–473. https://doi.org/10.7326/M18-0850

    Article  PubMed  Google Scholar 

  18. Mojadeddi Z, Harmankaya S, Rosenberg J et al (2022) Surgical Technique for primary perineal hernia: a systematic scoping review. https://osf.io/dzuex. Accessed 6 Oct 2022

  19. Covidence—better systematic review management. https://www.covidence.org/. Accessed 20 Oct 2022

  20. Mack JD, Hyde GA, Giles WH et al (2022) Robotic repair of a symptomatic perineal hernia with self-fixating synthetic mesh. Am Surg 88:2223–2224. https://doi.org/10.1177/00031348221091967

    Article  PubMed  Google Scholar 

  21. Kumari R, Tandup C, Agarwal A et al (2021) Rare case of angiofibroma presenting as perineal hernia. BMJ Case Rep 14:e236661. https://doi.org/10.1136/bcr-2020-236661

    Article  PubMed  PubMed Central  Google Scholar 

  22. Peña ME, Sadava EE, Matzner PM et al (2020) Primary perineal hernia: laparoscopic repair. Dis Colon Rectum 63:563. https://doi.org/10.1097/DCR.0000000000001515

    Article  PubMed  Google Scholar 

  23. Blecher V, Škach J, Verner T et al (2020) Primary perineal hernia: a case report. Rozhl Chir 99:326–328. https://doi.org/10.33699/PIS.2020.99.7.326-328

    Article  CAS  PubMed  Google Scholar 

  24. Palumbo VD, Di Trapani B, Molinelli B et al (2017) The saxophonist’s hernia: a rare case report of anterior primary perineal hernia in a young male patient. Clin Ter 168:133–135. https://doi.org/10.7417/CT.2017.1994

    Article  Google Scholar 

  25. Rodríguez-Wong U (2014) Hernia perineal posterior primaria. Reporte de un caso y revisión de la bibliografía [Primary posterior perineal hernia. Case report and review of the literature]. Cir Cir 82:93–97

    PubMed  Google Scholar 

  26. Prabhu R, Shenoy KR (2014) Primary perineal hernia: a differential diagnosis for Bartholin’s cyst in women. ANZ J Surg 84:686–687. https://doi.org/10.1111/ans.12265

    Article  PubMed  Google Scholar 

  27. Prakash K, Kamalesh PN (2013) Primary posterior perineal herniation of urinary bladder. J Minim Access Surg 9:126–127. https://doi.org/10.4103/0972-9941.115374

    Article  PubMed  PubMed Central  Google Scholar 

  28. Bunni J, Teichmann D, Berstock JR (2012) Pouch of Douglas pelvic hernia: a rare entity managed laparoscopically. Hernia 16:601–603. https://doi.org/10.1007/s10029-011-0788-y

    Article  CAS  PubMed  Google Scholar 

  29. Sorelli PG, Clark SK, Jenkins JT (2012) Laparoscopic repair of primary perineal hernias: the approach of choice in the 21st century. Colorectal Dis 14:72–73. https://doi.org/10.1111/j.1463-1318.2011.02807.x

    Article  Google Scholar 

  30. Washiro M, Shimizu H, Katakura T et al (2010) Using the uterus to close a pelvic defect after primary perineal posterior hernia repair: report of a case. Surg Today 40:277–280. https://doi.org/10.1007/s00595-008-4036-8

    Article  PubMed  Google Scholar 

  31. Succi L, Ohazuruike NL, Oliveri CE et al (2009) Perineal hernia: a case of outlet dysfunction. Chir Ital 61:127–130

    PubMed  Google Scholar 

  32. Rayhanabad J, Sassani P, Abbas MA (2009) Laparoscopic repair of perineal hernia. JSLS 13:237–241

    PubMed  PubMed Central  Google Scholar 

  33. Preiss A, Herbig B, Dörner A (2006) Primary perineal hernia: a case report and review of the literature. Hernia 10:430–433. https://doi.org/10.1007/s10029-006-0114-2

    Article  CAS  PubMed  Google Scholar 

  34. Weyhe D, Geier B, Belyaev O et al (2006) Central perineal hernia mimicking rectocele: a case report. Langenbecks Arch Surg 391:43–46. https://doi.org/10.1007/s00423-005-0007-3

    Article  PubMed  Google Scholar 

  35. Salum MR, Prado-Kobata MH, Saad SS et al (2005) Primary perineal posterior hernia: an abdominoperineal approach for mesh repair of the pelvic floor. Clinics 60:71–74. https://doi.org/10.1590/s1807-59322005000100013

    Article  PubMed  Google Scholar 

  36. Kuroki Y (2009) A case of primary anterior perineal hernia. Geka 62:1052–1054. https://doi.org/10.3919/jjsa.62.1052

    Article  Google Scholar 

  37. Padilla-Longoria R, Martinez-Munive A, Quijano-Orvananos F et al (1999) Tension free perineal hernioplasty: report of a case. Hernia. https://doi.org/10.1007/BF01194431

    Article  Google Scholar 

  38. Mandarano R, Giorgi G, Venturini N et al (1999) Ernia perineale [Perineal hernia]. Minerva Chir 54:523–529

    CAS  PubMed  Google Scholar 

  39. Jermy KV, Stanton SL, Nager CW et al (1999) A leiomyomatous perineal hernia? Br J Obstet Gynaecol 106:507–508. https://doi.org/10.1111/j.1471-0528.1999.tb08308.x

    Article  CAS  PubMed  Google Scholar 

  40. Sciacca P, Bertolini R, Borrello M et al (1998) Ernia perineale strozzata. Un raro caso di occlusione intestinale [A strangulated perineal hernia. A rare case of intestinal obstruction]. Minerva Chir 53:739–741

    CAS  PubMed  Google Scholar 

  41. Kelley WE Jr (2008) The evolution of laparoscopy and the revolution in surgery in the decade of the 1990s. JSLS 12:351–357

    PubMed  PubMed Central  Google Scholar 

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Funding

This study received no financial support from extramural sources.

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Authors and Affiliations

  1. Department of Surgery, Center for Perioperative Optimization, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark

    Z. M. Mojadeddi, S. Harmankaya, S. Öberg & J. Rosenberg

Authors
  1. Z. M. Mojadeddi
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  2. S. Harmankaya
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  3. S. Öberg
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  4. J. Rosenberg
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Corresponding author

Correspondence to Z. M. Mojadeddi.

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ZM reports no potential conflicts of interest. SH reports no potential conflicts of interest. SÖ reports no potential conflicts of interest. JR reports no potential conflicts of interest.

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Research did not involve human participants and/or animals so informed consent was not relevant. Ethics approval was not relevant for the present study.

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Mojadeddi, Z.M., Harmankaya, S., Öberg, S. et al. Surgical technique for primary perineal hernia repair: a systematic scoping review. Hernia 27, 751–763 (2023). https://doi.org/10.1007/s10029-023-02760-9

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