Safety and Efficacy of Pelvic Reinforcement Procedure for Preventing Postoperative Perineal Hernia After Robotic Abdominoperineal Resection: A Single-Center, Retrospective Cohort Study.

Aim: Few reports have described pelvic reinforcement procedure (PRP) to prevent perineal hernia (PH) in robotic abdominoperineal resection (Ro-APR) for rectal cancer. This study aimed to investigate the safety and efficacy of PRP in Ro-APR. Methods: Patients who underwent Ro-APR for rectal cancer between January 2020 and June 2023 were retrospectively examined. PRP was performed as a prophylactic procedure for PH. Four types of PRP were performed depending on the case (closure of the levator ani muscles, the pelvic peritoneum with the uterus, the pelvic peritoneum, and the pelvic peritoneum with a bladder peritoneal flap). Background factors and surgical outcomes were compared between patients without PRP (PRP-) and with PRP (PRP+). Imaged PH was diagnosed using computed tomography 1 year postoperatively. Imaged PH with symptoms was defined as symptomatic PH. Results: We evaluated 81 patients, including 51 PRP- (63.0%) and 30 PRP+ (37.0%). There were no differences in the characteristics between the two groups. There was no significant difference in operative time between the two groups (358 min vs. 329 min, p = 0.460). PRP- had a significantly higher rate of imaged PH (39.2% vs. 6.7%, p = 0.005) and symptomatic PH (19.6% vs. 3.3%, p = 0.047). The two groups had no significant differences in the other postoperative complications. In multivariate analysis, the independent risk factor for PH was not undergoing PRP (odds ratio 9.71, p = 0.005). Conclusion: PRP in Ro-APR for rectal cancer can be safely performed and helps prevent PH.