Two Cases of Secondary Anterior Perineal Hernia Repaired with a Pedicled Gracilis Muscle Flap

Secondary anterior perineal hernia (SAPH) is an extremely rare clinical entity. Due to the fragility of the posterior anchoring tissues, mesh repair carries a risk of late complications, such as rectal injury. Herein, we report 2 cases of male SAPH successfully repaired using a pedicled gracilis muscle flap.

Case 1: A man in his 70s developed a SAPH after undergoing a total cystectomy. Five years postoperatively, he presented with a bulging sensation in the perineal and scrotal regions, which caused significant discomfort, particularly when sitting. Physical examination revealed a protrusion extending from the base of the penis to the anus. Plain abdominal CT demonstrated herniation of the small intestine through a defect between the anus and the pubic bone, leading to a diagnosis of SAPH. The hernial sac was circumferentially dissected via a transperineal approach with the patient in the lithotomy position. A pedicled gracilis muscle flap was harvested from the left thigh, transposed through a subcutaneous tunnel, and packed into the hernial orifice. The flap was secured to the pubis, right ischium, and superficial transverse perineal muscle. No recurrence has been observed 3 months postoperatively. Case 2: A man in his 80s developed a hernia 1 year after a total cystectomy. Similar to Case 1, the hernia was repaired using a left gracilis muscle flap. No recurrence has been noted at the 15-month follow-up.

Repair using a pedicled gracilis muscle flap is an effective procedure that avoids mesh-related complications.