Perineal hernia is a well-known complication after abdominopelvic resection, but no consensus exists about the best technique for perineal hernia repair [[1], [3]]. As the patient presented with three prolapses of the colo-anal anastomosis requiring surgical repair with absolutely no adhesions before the perineal hernia repair, we chose a mesh repair to strengthen the pelvic floor and a direct perineal approach to perform levatorplasty. In 2016, the patient presented with three episodes of recurrent prolapse of the colo-anal anastomosis requiring resection of the prolapse and a new colo-anal anastomosis with anterior and posterior levatorplasty during the last intervention. [Extracted from the article]