Eight patients (seven male and one female) with symptomatic postoperative perineal hernias treated at the Cleveland Clinic Foundation from 1975 to 1986 are reviewed. The patients ranged in age from 43 to 68 years (mean, 61 years). Seven had previous abdominoperineal resections of the rectum and one had a pelvic exenteration. The first two patients underwent repair via a perineal approach and both had recurrences of their hernias. These recurrences, as well as the presenting hernias in the six later patients, were repaired with mesh placed through an abdominal approach. Of these, there was one recurrence, which was repaired via an abdominal approach. There was no operative mortality. Based on experience, the authors believe that the best method of repair for this uncommon problem, involves placement of Marlex® mesh across the pelvic inlet through an abdominal approach. This allows attachment to the mesh to the lateral musculature and posterior sacral periosteum under direct vision. The anterior borders of the mesh can be secured to the apex of the vaginal or prostatic tissue. The placement of metallic clips to the edges of the mesh allows for confirmation of the mesh position by radiographic examination during follow-up.