Abstract: Perineal hernia can be divided into congenital and acquired types based on its etiology. Acquired perineal hernia can be further divided into primary and secondary perineal hernias. Among them congenital and primary perineal hernias are very rare. Secondary perineal hernia is most common in perineal hernia after Miles′ operation, and closure of the pelvic peritoneum during Miles′ operation can effectively reduce the occurrence of secondary perineal hernia. Surgical repair is the only treatment for postoperative perineal hernia, but there is a lack of relevant consensus and guidelines. Based on comprehensive literature review and unit′s experience, the authors recommend to use synthetic mesh repair through the abdominal approach. Laparoscopy can be used first, and if necessary, open surgery can be performed in a timely manner. For complex and difficult cases, the combined approach of abdominal and perineal area can be considered, and even synthetic mesh combined with myofascial flap repair can be used. In mesh repair, surgeons should pay attention to the fixed position and shaping of the mesh to achieve sufficient fixation and reduce recurrence.