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

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.