Robotic Perineal Hernia Repair

Summer N Rochester, DO, Puraj P Patel, DO, William S Cobb, MD, Jeremy A Warren, MD, Alfredo M Carbonell, DO. Greenville Health System

Perineal hernia after abdominoperineal resection (APR) is a rare phenomenon.  There is a paucity of information on how best to repair this rare type of hernia.  We demonstrate a video of robotic repair of a perineal hernia after APR.  A 67-year-old man with a low rectal adenocarcinoma underwent neoadjuvant radiation with a subsequent APR.  This was followed with adjuvant chemotherapy.  Four weeks after completion of chemotherapy, the patient developed a large and obtrusive bulge in the perineum.  Computed tomography confirmed the presence of a perineal hernia through the pelvic floor with descent of the bowel below the coccyx.  The patient underwent robotic repair of the perineal defect utilizing a large polypropylene mesh as a hammock to reinforce the pelvic floor.  The patient recovered well and was discharged on postoperative day five.  After one year, the patient continues to do well and computed tomography demonstrates an intact hernia repair.  The robotic approach to perineal hernia repair may be a viable option for repair of this rare type of hernia.

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