Perineal Hernia in a Previously Operated Patient of Prolapse: A Case Report

Abstract

Perineal hernia can occur in patients after abdominal or pelvic surgeries, especially in those who are immunosuppressed, have a history of laparoscopy, or are of the female sex. Patients with a perineal hernia may be asymptomatic or complain of urinary or bowel disturbance or pain. Our patient was a 63-year-old symptomatic female with a history of vaginal hysterectomy and laparoscopic sacrospinous fixation. She presented with heaviness in the lower abdomen and increased stooling frequency. She was found to have a perineal hernia up to the right ischioanal fossa, with grade four vaginal vault prolapse. Laparoscopic sacrocolpopexy with levator ani plication with perineal hernia repair was performed. We used a T-shaped mesh composed of monofilament polypropylene with a combination of synthetic sutures to plicate the levator ani bilaterally and repair the vault prolapse. The postoperative course has been favorable. As of 12 months postoperative, there are no fresh complaints. The use of mesh (e.g., polypropylene) is important for levator ani repair for reinforcement. Laparoscopic repair is generally preferred, as it provides better access with a lesser risk of complication. Almost all cases of perineal hernia in literature have been after colorectal surgery and with no specific protocol for management. A standardized surgical approach with a scope for individualization would be helpful.