RADIOLOGICAL GRADING OF PERINEAL HERNIA AFTER MINIMALLY INVASIVE ABDOMINOPERINEAL RESECTION hasega@med.kobe-u.ac.jp

411-01

RADIOLOGICAL GRADING OF PERINEAL HERNIA AFTER MINIMALLY INVASIVE ABDOMINOPERINEAL RESECTION

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Japan

Oral or Poster

Perineal hernia (PH) is a relatively common complication following abdominoperineal resection (APR) by minimally invasive surgery (MIS), but its severity varies from patient to patient. We aimed to evaluate the severity of postoperative PH using the sagittal view of CT scans and to identify the risk factors for PH.

We retrospectively analyzed 126 patients who underwent APR with MIS for rectal cancer. PH was defined on postoperative follow-up CT as a viscera protrusion caudally from the pelvic outlet (the line connecting the lower end of the pubic symphysis and the coccyx). Grade A PH was defined as a visceral prolapse length of less than half of the pelvic outlet’s anterior-posterior diameter (APD), and grade B was a prolapse length of more than half the APD.

Of the 126 patients, 45 (35.7%) were female, 101 (80.2%) had a body mass index < 25, 58 (46.0%) underwent preoperative treatment, and 38 (30.2%) underwent omentoplasty. Grades B, and any grade of PH incidence at 5 years postoperatively were 25.8, and 47.2%, respectively. Multivariate analysis using the Cox regression model showed that female sex and omentoplasty were risk factors for any grade of PH, whereas female sex, BMI < 25, and preoperative treatment were risk factors for grade B PH.

The incidence of PH was 47.2%, of which 48.1% were Grade A with low need for treatment. Female sex, BMI < 25, and preoperative treatment were the risk factors for grade B PH.