Surgical Repair of Postoperative Perineal Hernia

Background The incidence of perineal hernia (PH) after abdominoperineal (AP) excision (classic or extralevator) ranges from 1 to 26%. The available data regarding the treatment of PH after rectal surgery are heterogeneous. Open or laparoscopic approach has been described. Material and Methods A 89-year-old woman was diagnosed of PH after laparoscopic AP resection due to rectal cancer five years ago. She presented pain associated with a reducible soft mass, increased with Valsalva maneuver and skin problems in perineal scar. Surgical repair by open approach was deemed necessary. She was positioned in jack-knife position. An elliptical incision was made. The hernia sac was of significant size and was in close contact with the perineal skin and vagina. The final defect measured 6 cm longitudinally by 5 cm transversely. Dissection of the hernia sac was performed until reaching the boundaries of the defect. The dissection was challenging in the region closest to the vagina due to firm adhesions. After sac closure, we continued the dissection to release the hernia sac at the pelvic rim, presacral, and lateral margins. The repair was performed using a prosthesis composed of ovine derived extracellular matrix and polypropylene measuring 10 × 15 cm*, fixed with continuous absorbable sutures, covering the mesh with approximation of the remain of levator muscles. Subcutaneous drain was placed. Conclusions We present one of the most used surgical techniques in incisional PH repair. *Ovitex 1S