Perineal hernia

Abdominoperineal excision of the rectum is a standard procedure in deep-lying rectal cancer if the sphincter muscle cannot be preserved. Besides common complications such as impotence, disorders of urinary tract function, and prolonged wound healing, perineal hernia is a rare long-term phenomenon. Surgical repair can be done either through a transabdominal approach or transperineally. Long-term results show that both methods are feasible in this situation. We report the third case of perineal hernia in German literature. A 66-year-old man presented with a painful perineal tumor 2 years after abdominoperineal excision for rectal adenocarcinoma. Perineal hernia was confirmed by magnetic resonance imaging, and the patient underwent open mesh repair through a perineal approach. A number of surgical techniques have been described for the repair of perineal hernias. These include abdominal, perineal, and combined or laparoscopic approaches with or without mesh repair. The transabdominal route seems to have some advantages over the perineal approach. In cases of small hernias, the latter can however be the option of choice. In the presented case of an uncomplicated hernia, we decided on the perineal approach including mesh implantation to keep the trauma as small as possible.