Perineal Hernias: Diagnosis and surgical management

Abstract

Perineal hernias are an uncommon but clinically significant condition faced by the colorectal surgeon, commonly as a complication following abdominoperineal resection or pelvic exenteration. Clinical presentation varies based on hernia size and contents, often involving gastrointestinal or urinary symptoms. Diagnosis primarily relies on clinical examination and cross-sectional imaging, with computed tomography as the preferred modality in acute settings. Although rare, perineal hernias can result in serious complications, including enterocutaneous fistulas, bowel obstruction, and herniation of pelvic organs. Management requires an individualized surgical approach based on defect size, hernia contents, and patient factors. Abdominal approaches, particularly open approaches, tend to offer lower recurrence rates compared to perineal repairs but are associated with longer recovery times. Mesh reinforcement is generally preferred for large defects, while flap reconstruction remains crucial for radiated or complex surgical fields. Despite advances in technique, recurrence remains a challenge, particularly following primary suture repairs. Reconstructions with synthetic mesh via abdominal or perineal approaches, with or without flaps, may provide the best outcomes.