Laparoscopic repair of perineal hernia after abdominoperineal excision.

PURPOSE: Perineal hernia is a challenging complication after abdominoperineal excision (APE) of the rectum. Surgical repair can be accomplished using challenging abdominal or transperineal approaches. A laparoscopic repair using a Proceed mesh might be an easy and effective alternative. METHODS: We describe a multi-center case-series of twelve patients with a symptomatic perineal hernia treated by laparoscopic mesh repair. A cone-shaped 10 × 15 cm Proceed Mesh was tacked to the promontory or sacrum and sutured to the pelvic sidewalls and the anterior peritoneum. RESULTS: Twelve patients underwent laparoscopic repair of their perineal hernia. Four men and eight women presented with a symptomatic perineal hernia after abdominoperineal excision between 2008 and 2013 and underwent a laparoscopic repair with a Proceed mesh. The median age at presentation was 53 years (range 39-68 years). The mean total theater time was 119 min (range 75-200 min). No conversion to an open procedure was needed. No early complications where seen. The mean hospital stay was 2.25 days (range 1-4 days). Three patients showed recurrence, of whom two had a defect in the middle of the proceed mesh, one had a defect anterior to the previous perineal hernia. All 3 patients underwent a redo-laparoscopic repair with mesh. CONCLUSION: In this case series we present an alternative approach for the surgical repair of perineal hernias. Based on our experience, perineal hernia after APE can be repaired safely and effectively using the described laparoscopic technique.

Vasculitis revealed by posterior stroke.

Posterior ischaemic stroke is relatively uncommon, and its occurrence should alert clinicians to possible uncommon underlying disease. We report a patient with occipital brain infarction. The combination of age, gender, general malaise and elevated erythrocyte sedimentation rate led to the clinical suspicion of giant cell arteritis. Vertebral artery vasculitis was confirmed by 18-FD G positron emission tomography, combined with CT angiography, and immediate immunosuppressive therapy was started. Symptoms of stroke should, in a particular clinical context, raise suspicion of giant cell arteritis.