Authors: J M Ali A Stabler N R Hall M Irwin R Miller N S Fearnhead
Publish Date: 2012/06/28
Volume: 17, Issue: 4, Pages: 545-549
Abstract
Acquired perineal hernias through the reconstructed pelvic floor can complicate radical pelvic operations including abdominoperineal resection of rectum Operative intervention is indicated for symptomatic hernias There is a lack of consensus as to the best operative technique Here we present a novel method for repairing perineal herniation using salinefilled tissue expandersPerineal hernia repair may be affected either via an abdominal or via a perineal approach After adhesiolysis to remove small bowel from the pelvis a Natrelle™ 150SH tissue expander Allergan Inc California USA or Siltex™ Round Becker Mentor Medical Systems Holland of appropriate size is inserted in the pelvis and the button placed in a subcutaneous pocket in the perineal skin The tissue expander is then filled with saline until it fills the true anatomical pelvis without bladder compression The volume may be increased or decreased postoperatively by accessing the subcutaneous buttonWe have performed this procedure in three patients with some success all of whom have experienced symptomatic relief The tissue expander may subsequently be removed without recurrence of symptoms due to the fibrous capsule which forms One patient required reoperation to elevate a herniating tissue expander The tissue expander was removed earlier than anticipated to avoid deep pelvic infection in another
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