Dataset Information

Robotic repair of perineal hernias: a video vignette and review of the literature.

ABSTRACT:

Background

Perineal hernias can be secondarily acquired following abdominoperineal resection of the rectum. While transabdominal minimally invasive techniques have traditionally used laparoscopy, there are few studies published on the robotic platform, which has been gaining popularity for other types of hernia repairs. We review the existing literature, share a video vignette, and provide practical tips for surgeons interested in adopting this approach.

Methods

A literature search in Pubmed was performed to include all articles in English describing robotic repair of perineal hernias with identification of variables of interest related to repair. A case presentation with an accompanying video vignette and lessons learned from the experience are provided.

Results

Seven case reports (four containing video) published between 2019 and 2022 were included. Most articles (n = 5) utilized the Da Vinci Si or Xi, and most patients (n = 5) had undergone abdominoperineal resection with neoadjuvant chemotherapy to treat rectal cancer. Patients were positioned in Trendelenburg with rightward tilt (n = 2), modified lithotomy (n = 1), or a combination of the two (n = 1). All articles (n = 7) reported closing the defect and using mesh. Three articles describe placing five ports (one camera, three robotic, one assistant). There were no significant intraoperative or postoperative complications reported, and no recurrence noted at 3-27 months follow-up. Based on our experience, as shown in the video vignette, we recommend lithotomy positioning, using porous polypropylene mesh anchored to the periosteum of the sacrum and peritoneum overlying the bladder and side wall, and placing a drain above the mesh.

Conclusions

A robotic transabdominal approach to perineal hernia repair is a viable alternate to laparoscopy based on low complication rates and lack of recurrence. Prospective and longer duration data are needed to compare the techniques.

SUBMITTER: Watanaskul S

PROVIDER: S-EPMC10017789 | biostudies-literature | 2023 Mar

REPOSITORIES: biostudies-literature

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Publications

Robotic repair of perineal hernias: a video vignette and review of the literature.

Watanaskul Sarah S Schwab Marisa E ME Colley Alexis A Chern Hueylan H Varma Madhulika G MG Hoffman William Y WY Sarin Ankit A

Surgical endoscopy 20220818 3

<h4>Background</h4>Perineal hernias can be secondarily acquired following abdominoperineal resection of the rectum. While transabdominal minimally invasive techniques have traditionally used laparoscopy, there are few studies published on the robotic platform, which has been gaining popularity for other types of hernia repairs. We review the existing literature, share a video vignette, and provide practical tips for surgeons interested in adopting this approach.<h4>Methods</h4>A literature searc ...[more]

PMID: 35982283

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Project description:BackgroundPostoperative perineal hernia (PH) is an uncommon complication after abdominoperineal resection (APR). Different techniques have been described in literature and there is no consensus regarding the optimal repair approach. In the present study, we reported a case of a laparoscopic combined repair of a perineal hernia and abdominal parastomal hernia (PSH) with mesh. Studies have shown that the prosthetic PSH and PH repair can be performed at the same time by laparoscopy with the same trocars positioning, adding the advantages of minimally invasive surgery and avoiding large laparotomy.MethodsA literature search in Pubmed was performed. All articles in English describe laparoscopic repair of combined perineal and parastomal hernias. A case presentation of an 83-year-old woman with combined parastomal and perineal hernias after abdominoperineal resection (APR) shown in a video vignette is provided.ResultsThree single patient case reports published between 2016 and 2023 were found in literature. Two patients with rectal cancer underwent APR procedure, while the third patient underwent an anterior pelvic exenteration (APE) for carcinoma of the urinary bladder (CUB). The laparoscopic procedures did not require conversion and all procedures successfully closed the defect using a mesh. In our case, the operative time was 3 h with the major time spent for PH repair. The intraoperative blood loss was non-significant and the postoperative course was regular. The patient has been discharged on the fourth postoperative day. At 1 year follow-up, the patient noticed a great improvement in her daily-life due to the absence of the previous discomforts and there was no evidence of early recurrence or other postoperative complications.ConclusionCombined laparoscopic transabdominal PH and PSH repair with the use of synthetic mesh was shown to be a safe and effective repair for this rare disorder. To accurately compare techniques, we require prospective studies with longer follow up durations.

Dataset Information

Robotic repair of perineal hernias: a video vignette and review of the literature.

Background

Methods

Results

Conclusions

Publications

Robotic repair of perineal hernias: a video vignette and review of the literature.

Similar Datasets

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