Recurrent perineal hernia repair: a novel approach.

PURPOSE

Postoperative perineal hernias are rare complications from procedures, which compromise the pelvic floor, mainly abdominoperineal resection, proctocolectomy, and partial or total pelvic exenteration. Surgical repair can be accomplished through abdominal, laparoscopic, or transperineal approaches.

METHODS

We present a case report of a 70-year-old man who underwent two prior operations for recurrent perineal hernia and was ultimately successfully treated with a third operation, a synthetic mesh redo procedure that utilized a synthetic mesh system marketed for women with pelvic organ prolapse.

RESULTS

Although there is no "gold standard" for perineal hernia repair, our patient had multiple surgeries employing a variety of approaches. Final success was achieved using a mesh system with improved fixation to secure pelvic ligaments, using an exclusive perineal approach. Now, more than five years following the final surgery, the patient remains symptom free with no clinical evidence of perineal hernia recurrence.

CONCLUSIONS

To date, this is the only report of using this mesh system in a male. The advantages of using this mesh system are (1) exclusive perineal approach without the accompanying risks of abdominal or laparoscopic approach; (2) improved fixation of mesh to secure pelvic ligaments; and (3) lightweight, flexible, and large mesh shape that can easily be trimmed to allow versatility in procedures.