From the Guidelines
Pelvic wall hernias should be treated with surgical repair, which can be performed through open, laparoscopic, or robotic approaches, and often includes mesh reinforcement to prevent recurrence, as this approach has been shown to reduce morbidity, mortality, and improve quality of life 1.
Diagnosis and Treatment
Pelvic wall hernias are rare defects in the pelvic floor musculature that allow abdominal or pelvic contents to protrude through abnormal openings. These hernias include obturator, sciatic, perineal, and levator ani hernias. Diagnosis typically requires imaging such as CT or MRI scans as physical examination alone may miss these deep hernias.
- The surgical technique typically includes reduction of herniated contents, closure of the defect, and often mesh reinforcement to prevent recurrence.
- The use of mesh in clean surgical fields is associated with a lower recurrence rate, without an increase in the wound infection rate, and is recommended for patients with intestinal incarceration and no signs of intestinal strangulation or concurrent bowel resection 1.
Risk Factors and Complications
These hernias frequently present with vague symptoms including pelvic pain, pressure sensations, or bowel/bladder dysfunction. Risk factors include previous pelvic surgery, radiation therapy, pregnancy, and conditions that increase intra-abdominal pressure.
- Early intervention is recommended as these hernias can lead to complications such as bowel obstruction or strangulation.
- Systemic inflammatory response syndrome (SIRS), contrast-enhanced CT findings, as well as lactate, CPK, and D-dimer levels are predictive of bowel strangulation, and patients should undergo emergency hernia repair immediately when intestinal strangulation is suspected 1.
Recovery and Management
Recovery typically takes 4-6 weeks, with activity restrictions gradually lifting as healing progresses.
- Due to their rarity and anatomical complexity, management by surgeons experienced in pelvic floor disorders is optimal for best outcomes.
- The component separation technique may be a useful and low-cost option for the repair of large midline abdominal wall hernias, and can be considered as a viable alternative for patients with complicated hernias 1.
From the Research
Pelvic Wall Hernia
- A pelvic wall hernia is a rare condition that can cause chronic pain, bowel obstruction, and urinary disorders.
- The treatment of pelvic wall hernia is surgical, usually consisting of mesh repair via an abdominal or perineal approach 2, 3, 4.
- Laparoscopic repair is a safe and feasible option for pelvic wall hernia, but further studies are needed to evaluate the best surgical approach and type of mesh 2, 4.
Symptoms and Diagnosis
- Common symptoms of pelvic wall hernia include pain, discomfort, and a bulge in the perineal area 3.
- Diagnostic methods such as MRI scans can be used to visualize the hernia 3.
- Physical examination can also be used to diagnose pelvic wall hernia, with a bulge often found in the perineal area 3.
Surgical Techniques
- Different surgical procedures can be used to repair pelvic wall hernia, including laparotomy and the use of a permanent mesh 3.
- Laparoscopic repair is a minimally invasive option that can be used to repair pelvic wall hernia 2, 4.
- The choice of surgical technique depends on the individual patient's condition and the surgeon's expertise 5.
Outcomes and Complications
- The postoperative course for pelvic wall hernia repair is often uneventful, with no severe intraoperative events reported 3.
- Complication and recurrence rates for laparoscopic hernia repair have decreased over time, with proper patient selection and surgeon training 5.
- Further studies are needed to evaluate the long-term outcomes and complications of pelvic wall hernia repair 2, 3.