Perineal hernia repair after extralevator abdominoperineal excision, how we do it (PERineal Laparoscopic Sling: PERLS Technique)

Purpose Recent shift to radical extralevator abdominoperineal excision (ELAPE) approach has seen an increased incidence of post-operative perineal hernia. However, there is no standardised surgical approach for its repair. The aim of this study was to report intra and post-operative results of the perineal hernia repair by the novel trans-abdominal PERineal Laparoscopic Sling (PERLS) Technique in patients who developed post-operative perineal hernia following ELAPE. Methods This is a retrospective analysis of consecutive patients who underwent perineal hernia repair by laparoscopic PERLS approach. All patients had undergone ELAPE with vertical rectus abdominis muscle (VRAM) flap reconstruction during the index surgery for treatment of rectal cancer. Post-operative complications, operative time, conversion rate to open surgery and incidence of recurrent perineal hernia were noted. Results Seven patients were operated for perineal hernia. The mean operative time was 105 min (range: 87 to 131 min). One case needed conversion to the open approach. The incidence of early complications was 57.1% including just single Clavien-Dindo I and two Clavien-Dindo II complications, while recurrence rate was 14.3%. Conclusion PERLS perineal hernia repair is safe, performed in convenient time duration (mean = 105 min) and has reasonably less recurrence rate.