Perineal Approach, the Closest Approach to the Pelvic Floor, in Perineal Hernia Repair After Abdominoperineal Resection
Perineal Approach, the Closest Approach to the Pelvic Floor, in Perineal Hernia Repair After Abdominoperineal Resection
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会阴入路，最接近盆底的入路，用于腹会阴切除术后会阴疝修补术
DOI：
10.1097/dcr.0000000000002442
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发表时间：
2022
影响因子：
3.9
通讯作者：
Ishihara Soichiro
中科院分区：
文献类型：
--
作者：
Komatsu Koichi;Emoto Shigenobu;Abe Shinya;Nozawa Hiroaki;Kawai Kazushige;Sasaki Kazuhito;Murono Koji;Ishihara Soichiro
腹会阴切除术（APR）后重做盆腔深部手术通常很困难，因为盆腔器官或肠道与盆底粘连，并且对于有放射或盆腔外侧淋巴结清扫史的患者具有挑战性。随着APR后会阴疝病例数量的增加，报告了几例使用不同技术进行会阴疝修补的病例。相对较新的技术包括皮瓣重建、使用生物补片和使用胶水固定补片。1然而，由于缺乏高质量的证据，很难确定哪种技术更上级。2虽然会阴疝修补术没有标准，但系统综述表明，主要方法是会阴入路，使用补片进行修补很常见。3在此，我们介绍了1例传统APR（非提肛器外APR）术后会阴疝伴严重盆腔内粘连的病例，经会阴入路使用复合补片成功修复。我们可以在最近的视野和直接的触觉信息下进行粘连松解术，避免肠道损伤和污染。患者是一名82岁的男性，患有会阴疝，在新辅助放化疗和机器人APR联合盆腔外侧淋巴结清扫术治疗直肠腺癌后1.5年变得明显。原会阴部缺损的患者接受了2层（皮下组织和皮肤）的简单闭合，无需皮瓣。使用会阴入路，可以在最接近骨盆底的视野和复合补片展开的情况下进行安全的粘连松解术。程序细节与关键技术点。未发生围手术期/术后并发症，5个月门诊随访时未观察到复发。据我们所知，目前还没有经会阴入路粘连松解术的视频报道。我们的视频强调了这种方法的好处，它提供了一个近距离和直接的看法骨盆底。参见http：//links上的视频。lww。com/DCR/B943。
Redo deep pelvic surgery after abdominoperineal resection (APR) is usually difficult owing to the adhesion of the pelvic organs or intestines to the pelvic floor and is challenging in patients with a history of irradiation or lateral pelvic lymph node dissection. With the number of perineal hernia cases after APR increasing, several cases of perineal hernia repair using different techniques have been reported. Relatively new techniques include reconstruction with a flap, use of biological mesh, and use of glue for mesh fixation. 1 However, a lack of quality evidence makes it difficult to determine which technique is superior. 2 Although there is no criterion standard for perineal hernia repair, a systematic review showed that the major approach is the perineal approach and that repair using a mesh is common. 3 Here, we present a case involving a perineal hernia with severe intrapelvic adhesion after conventional APR (not extralevator APR), which was repaired successfully using a composite mesh through the perineal approach. We could perform adhesiolysis with the closest view and direct tactile information, avoiding intestinal damage and contamination.The patient was an 82-year-old man with a perineal hernia that became apparent 1.5 years after neoadjuvant chemoradiotherapy and robotic APR with lateral pelvic lymph node dissection for rectal adenocarcinoma. The patient with the original perineal defect underwent simple closure by 2 layers (subcutaneous tissue and skin) without a flap. Using the perineal approach, safe adhesiolysis could be performed with the closest view and composite mesh deployment to the pelvic floor. Procedural details are presented with key technical points. No perioperative/postoperative complications occurred and no recurrence was observed at a 5-month outpatient follow-up. To our knowledge, there is no video report of adhesiolysis through the perineal approach. Our video emphasizes the benefit of this approach, which provides a close and direct view of the pelvic floor. See Video at http://links. lww. com/DCR/B943.