Perineal Hernia repair using bone fixation anchoring system for the mesh- video vignette.

The extralevator abdominoperineal excision (ELAPE) has been introduced to overcome the high rates of bowel perforation and positive circumferential resection margin (CRM) associated with traditional abdominoperineal resection (APR). The literature supports oncological superiority of ELAPE but acknowledges higher perineal wound morbidity. This includes perineal hernia, especially with neoadjuvant radiotherapy. The prophylactic use of biological mesh for repair of the perineal defect after ELAPE has been shown to significantly reduce perineal hernia rates compared with primary closure. Perineal hernia rate is reported at 3.4% even with the use of prophylactic biological mesh.