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Posterior Perineal Hernia Repair Using Sacrocolpopexy Mesh

Andrea M. Avondstondt, MD; Dima Ezzedine, MD; Charbel Salamon, MD,MS

Product Details
Product ID: ACS-5615
Year Produced: 2018
Length: 7 min.
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Perineal hernias are the abnormal protrusion of intra-abdominal structures through a levator plate defect into the perineal area. Asymptomatic patients may choose observation but symptomatic patients typically require surgical intervention. Due to the rarity of this condition, the ideal surgical approach to perineal hernia repair is not well established. Objective: We present the case of a posterior perineal hernia repaired robotically using permanent sutures and mesh. A concomitant supracervical hysterectomy and colpopexy was performed. Methods: This video presentation reports a 67-year-old woman complaining of worsening pelvic bulge symptoms. Her history was remarkable for polymyalgia rheumatic, 4 vaginal deliveries, 1 cesarean section, and posterior repair 14 years prior. On examination, a large left-sided perineal hernia containing small bowel was found in addition to stage 3 uterovaginal prolapse. A minimally invasive robotic-assisted abdominal approach was chosen for repair. Upon entry into the abdominal cavity, a 4 cm left-sided levator defect was noted with a 6 cm hernia sack in contact with perineal skin. The hernia sack excised and the defect closed with permanent suture. The posterior arm of sacrocolpopexy mesh was used to reinforce the hernia repair. A supracervical hysterectomy and sacrocolpopexy were performed concomitantly to treat the uterovaginal prolapse. Results: At 14 month follow up, the patient is symptom-free. Robotic-assisted surgical repair of this perineal hernia offered excellent intra-operative visualization and complete delineation of the defect with clear visualization of surrounding pelvic structures. Conclusions: Increased reporting in urogynecology literature may help guide optimal treatment for practitioners.