VIDEO FORUM Laparoscopic prosthetic parastomal and perineal hernia repair after abdominoperineal resection G. Dapri 1,2 • L. Gerard 1 • L. Cardinali 1 • D. Repullo 1 • I. Surdeanu 1 • S. H. Sondji 1 • G.-B. Cadie `re 1 • S. Saussez 2 Received: 4 November 2016 / Accepted: 11 December 2016 Ó Springer International Publishing AG 2016 Introduction Abdominoperineal resection (APR), described since 1908 [1], is a procedure performed for low rectal cancer when sphincter preservation is not feasible. Patients who undergo this procedure can present some late complications, like parastomal and perineal hernias. Parastomal hernia (PSH) is an incisional hernia located at or immediately adjacent to a stoma, reported with an inci- dence of up to 76% of patients with a stoma, usually occur- ring within 2 years of ostomy creation, but sometimes up to 20 or 30 years after surgery [2]. It is related to increasing age, abdominal obesity, poor nutritional status, corticosteroid use, increased intraabdominal pressure, and other predis- posing disorders. Laparoscopy permits a more precise repair, and the preferred options are currently the Sugar- baker/modified Sugarbaker or ‘‘sandwich’’ techniques instead of the keyhole technique [3]. The results of PSH repair have been disappointing, with reported recurrence rates of 30–76% after local aponeurotic repair, stoma relocation, and laparoscopic repair, with, probably, the need for mesh placement at the time of stoma formation [4]. Perineal hernia (PH) is a defect between the levator ani and the coccygeus muscles, which occurs in \ 1–3% of patients [5–7]. It can be classified as primary (congenital or due to laxity in the pelvic floor musculature) or secondary (after APR, extralevator APR, pelvic exenteration). Secondary postoperative perineal hernia is usually asymptomatic, but it can cause discomfort while sitting, skin erosion over the herniated sac, intestinal obstruction, difficult micturition secondary to herniation of the urinary bladder or evisceration. PH occurs more frequently in female patients due to the conformation of the small pelvis, to the frequency of preex- isting prolapses, and to pelvic floor fragility associated with pregnancy and parturition [5]. Other possible risk factors are previous hysterectomy, coccygectomy, preoperative pelvic radiation, long small-bowel mesentery, perineal wound infection, and non-closure of the pelvic peritoneum at the time of rectal surgery [8]. Surgical repair can be through the abdomen, through the perineum or combined. In a patient presenting both PSH and PH, simultaneous open abdominal repair requires a quite large incision to get access to the abdomen as well as to the pelvis. Another option is to separate the open abdominal access for PSH from the open perineal approach for the PH. On the other hand, abdominal laparoscopy offers a good solution because both repairs can be performed using the same trocars disposition. Moreover, laparoscopic repair can add the known advantages of minimally invasive surgery like shorter hospital stay, reduced wound infection rate, improved patient comfort, and better cosmetic results. The authors report a 74-years-old female, with a 30.3 kg/m 2 body mass index, with episodes of intestinal occlusions following a procedure of open APR, performed 6 years before for rectal adenocarcinoma (pT2N0M0). Electronic supplementary material The online version of this article (doi:10.1007/s10151-016-1573-9) contains supplementary material, which is available to authorized users. This video will be presented at the 18th Annual Americas Hernia Society, Cancun (Mexico), March 8–11, 2017 & G. Dapri giovanni@dapri.net 1 Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery, Saint-Pierre University Hospital, Universite ´ Libre de Bruxelles, 322, Rue Haute, Brussels, Belgium 2 Laboratory of Anatomy, Faculty of Medicine and Pharmacy, University of Mons, Mons, Belgium 123 Tech Coloproctol DOI 10.1007/s10151-016-1573-9