Challenging Perineal Hernia Management Following Extralevator Abdominoperineal Excision: A Compelling Case Report

Abstract

This case report describes a rare perineal hernia complication following laparoscopic extralevator abdominoperineal excision in a patient with low rectal adenocarcinoma. The patient presented with a reducible perineal swelling over the surgical scar, which was diagnosed as a pelvic floor defect containing a small bowel loop and mesentery. The hernia was repaired one year following the index surgery using a transperineal approach with synthetic mesh and suture fixation to anatomical landmarks. The patient remained free of hernia recurrence one year following the repair and had an improved quality of life. This report highlights the importance of careful planning and individualized surgical management in the repair of perineal hernias following complex pelvic surgery.