Asian Journal of Case Reports in Surgery

Posterior Perineal Hernia and Its Repair by Combined Laparoscopic-Perineal Approach: Clinical Case Report

Esther Robinson *

Department of General Surgery, Kovai Medical Center and Hospital Ltd., Avinashi Road, Coimbatore-641014, Tamilnadu, India.

T. Sathesh Kumar

Department of General Surgery, Kovai Medical Center and Hospital Ltd., Avinashi Road, Coimbatore-641014, Tamilnadu, India.

Sadula Ajith

Department of General Surgery, Kovai Medical Center and Hospital Ltd., Avinashi Road, Coimbatore-641014, Tamilnadu, India.

*Author to whom correspondence should be addressed.

---

Abstract

Aims: To discuss a rare type of perineal hernia and its successful repair by combining laparoscopic and transperineal approaches.

Presentation of Case: 45 years old multiparous woman presented with a gluteal swelling, progressing in size and associated with ulceration of swelling. Patient had undergone abdominal hysterectomy and ovarian cystectomy in the past. Clinical examination showed a large perineal hernia and its contents were delineated by computed tomography. Patient was offered surgical repair. Owing to large size of the sac and dense bowel adhesions inside the sac, laparoscopic reduction was complemented by perineal mobilization of the contents. Better visualization provided by laparoscopy facilitated pelvic mesh fixation with ease.

Discussion: Perineal hernias are rare and various approaches have been described for repair of perineal hernias including open transabdominal, transperineal or combined abdominoperineal repairs. We present a case report of posterior perineal hernia in a female patient who presented with a mass in the gluteal region. Surgical repair with synthetic mesh was performed using a combination of laparoscopic and transperineal approaches. Thus, combined approach can be beneficial to tackle large perineal hernia as described in this case report.

Conclusion: Symptomatic perineal hernias require surgery and synthetic mesh repair using combined approach (laparoscopic and perineal) allows successful repair.

Keywords: Posterior perineal hernia, surgical repair, mesh repair, laparoscopic approach

---

---

---

References

Stamatiou D, Skandalakis JE, Skandalakis LJ, Mirilas P. Perineal hernia: surgical anatomy, embryology, and technique of repair. Am Surg. 2010;76(5):474-9.

PMID: 20506875

Aboian E, Winter DC, Metcalf DR, Wolff BG. Perineal hernia after proctectomy: prevalence, risks, and management. Dis Colon Rectum. 2006;49(10):1564-1568.

DOI: 10.1007/s10350-006-0669-0.

Morcos BB, Al-Masri M, Baker B. Perineal hernia, another incisional hernia? Indian J Surg. 2009;71:112–116.

Penkov N, Damianov D, Asenov Y, Gerzilov P, Sedloev T. Recurrent perineal hernia-case report and review of the literature. Chirurgia (Bucur). 2015;110:81.

Wong KW, Lai TC, Ng AT, Ho BS, Tsu JH, Tsang CF, Ma WK, Yiu MK. Anterior perineal hernia after anterior exenteration. Asian J Urol. 2017;4(4):253-255.

DOI: 10.1016/j.ajur.2017.03.002.

Epub 2017 Mar 14. PMID: 29387558; PMCID: PMC5772902.

Salameh JR. Primary and unusual abdominal wall hernias. Surg Clin North Am. 2008;88:45–60.

Dulucq JL, Wintringer P, Mahajna A. Laparoscopic repair of postoperative perineal hernia. Surg Endosc. 2006;20(3):414-8.

DOI: 10.1007/s00464-005-0193-7. PMID: 16437278.

Honjo K, Sakamoto K, Motegi S, Tsukamoto R, Munakata S, Sugimoto K, et al. Case report of perineal hernia after laparoscopic abdominoperineal resection. Asian J Endosc Surg. 2018;11(2):173–6.

Gómez Portilla A, Cendoya I, Uzquiza E, Martin E, Martinez de Lecea C, Gómez C, Romero EE. Giant perineal hernia: laparoscopic mesh repair complemented by a perineal cutaneous approach. Hernia. 2010;14(2):199-201.

DOI: 10.1007/s10029-009-0519-9.

Epub 2009 Jun 3. PMID: 19495919.

Goedhart-de Haan AM, Langenhoff BS, Petersen D, Verheijen PM. Laparoscopic repair of perineal hernia after abdominoperineal excision. Hernia. 2016;20(5):741-6.

DOI: 10.1007/s10029-015-1449-3.

Epub 2015 Nov 30. PMID: 26643606.

Sorelli PG, Clark SK, Jenkins JT. Laparoscopic repair of primary perineal hernias: the approach of choice in the 21st century. Colorectal Dis. 2011;14:72-73.

Mjoli M, Sloothaak DA, Buskens CJ, Bemelman WA, Tanis PJ. Perineal hernia repair after abdominoperineal resection: a pooled analysis. Colorectal Dis. 2012; 14(7):e400–e406.

DOI: 10.1111/j.1463-1318.2012.02970.