EP 054 Expanding Horizons: Robotic-Assisted Mesh Repair for Perineal Hernia

Abstract

Perineal hernia repair remains a challenging procedure due to its complex anatomical location, especially in patients with prior surgical interventions. We report the successful use of the da Vinci Xi robotic platform for mesh-based repair of a perineal hernia in an 83-year-old male with a history of abdominoperineal resection and multiple comorbidities. Preoperative imaging revealed a moderate-sized, fluid-filled hernia protruding through the pelvic floor. The robotic approach enabled meticulous adhesiolysis, safe reduction of small bowel, and precise identification of the perineal defect. A coated mesh, tailored to 6.5 × 7.5 cm to ensure adequate coverage, was placed in the preperitoneal space and secured using interrupted sutures and surgical adhesive. The peritoneum was reapproximated over the mesh to minimize bowel contact and reduce postoperative complications. Robotic assistance provided enhanced visualization, dexterity, and stability, facilitating accurate dissection and optimal hemostasis. This case demonstrates the feasibility and safety of robotic-assisted perineal hernia repair, highlighting its potential advantages in complex pelvic surgery, including improved precision, reduced risk of recurrence, and favorable integration of mesh within the preperitoneal space.

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