Perineal Hernia

Introduction

Abdominoperineal resection (standard and extralevator) and pelvic exenteration are frequently performed operations. During follow-up, many patients demonstrate a perineal bulging with increases in abdominal pressure (especially during coughing, straining, or a Valsalva maneuver). This perineal hernia develops because a large portion of the pelvic floor has been removed. If an extended resection (extralevator abdominoperineal or exenteration) is performed, the defect can be particularly large, allowing the small bowel to descend into and through the pelvis. Although postoperative perineal hernias are common, they are usually asymptomatic. Symptoms that occur vary from a painless but noticeable perineal bulge to a painful bulge, bowel or urinary obstruction, and even an ischemic breakdown of the perineal skin. The incidence of hernias requiring repair has been estimated to be 1% to 7% of abdominoperineal resections and 10% of pelvic exenterations; however, the condition is under-reported, with fewer than 75 cases included in the literature. This chapter discusses evaluation, treatment, and prevention of perineal hernias.

Therapy