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Long‐term follow up in two cases of pelvic reconstruction using a combined VRAM flap‐sacrocolpopexy for severe perineal hernia after abdominoperineal resection
Author(s) -
Yamamoto Shotaro,
Hamuro Akihiro,
Nagahara Hisashi,
Motomura Hisashi,
Koyama Masayasu,
Tachibana Daisuke
Publication year - 2022
Publication title -
journal of obstetrics and gynaecology research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.597
H-Index - 50
eISSN - 1447-0756
pISSN - 1341-8076
DOI - 10.1111/jog.15098
Subject(s) - medicine , abdominoperineal resection , perineum , surgery , pelvic floor , concomitant , hernia , surgical mesh , cancer , colorectal cancer
Abstract Perineal hernia is an infrequent complication of abdominoperineal resection (APR) and, currently, there is no consensus as to the optimal operative technique. Surgical repair can be achieved by either cerclage or the use of mesh or autologous tissue, and it has been reported that the recurrence rate after repair using autologous tissue is 33%. We present two post‐APR cases of severe perineal hernia with pelvic organ prolapse (POP) which did not improve after repair using mesh. We regenerated the pelvic floor using a vertical rectus abdominis myocutaneous (VRAM) flap and performed a concomitant sacrocolpopexy to fix the POP. Drooping of the perineum and pelvic floor was greatly improved, and the patients have not experienced any recurrence for 6 years. This dual procedure has not been previously mentioned in the literature, and we consider this the first report of its kind.