Laparoscopic Mesh Repair for Perineal Hernia after En Bloc Resection of an Aggressive Angiomyxoma using a Modified Sacral-Colpopexy Technique.

To demonstrate laparoscopic mesh repair of perineal hernia (PH) by a modified sacral-colpopexy technique.Step-by-step demonstration of the technique used for the surgical repair of PH after gynecologic surgery. (Canadian Task Force Classification III) SETTING: PH is defined as a pelvic floor defect through which the intra-abdominal viscera may protrude [1].The reported incidence of PH ranges from 0.6% to 3%, and it generally occurs after rectal or prostate surgery [2]. Due to the low incidence, there has been no standard procedure to repair PH [3]. Herein, we demonstrate a successful case of PH repair with a composite mesh (Dual Mesh®) after a gynecological surgery by a modified laparoscopic sacral-colpopexy technique which was approved by our Institutional Review Board.The patient had undergone extralevator abdominoperineal excision for an aggressive angiomyxoma and a sigmoid-colon-protrudent PH occurred after the surgery [4]. The patient suffered from defecatory dysfunction and dysmenorrhea. Total laparoscopic hysterectomy, bilateral salpingo-oophorectomy (TLH BSO), and mesh repair of the PH were performed at 2 years after the primary surgery, and they were successful without any intraoperative or postoperative complication. As the pelvic floor defect was too large to secure the mesh by simple placement, we applied the modified sacral-colpopexy technique using 2-0 proline to cover and support this defect. At 12 months after the second surgery, there was no sign of recurrence of PH and aggressive angiomyxoma, and the preoperative symptoms diminished.Laparoscopic mesh repair by modified sacral-colpopexy technique is safe and effective to manage a PH.