Repair of vaginal prolapse and perineal hernia after pelvic exenteration

Perineal hernias have been a significant complication of pelvic exenteration since the inception of this procedure. A variety of natural and artificial materials have been used to support the small bowel to prevent its descent into the lower pelvis with subsequent hernia and fistula formation. More recently, neovagina construction using gracilis myocutaneous flaps has provided both sexual function and support for the small bowel. A patient is presented who had prolapse of her neovagina and a perineal hernia 12 months after exenterative surgery. A technique to repair this complication is described, and a possible method of preventing it is discussed.