Perineal hernia after Miles' operation refers to a hernia in which abdominal or pelvic organs protrude through a pelvic floor defect or area of weakness resulting from the Miles procedure into the perineal region. Once a perineal hernia has developed after Miles' operation, surgical repair is the only effective treatment. This article focuses on the pathogenesis and surgical management of perineal hernia following Miles' operation, with particular emphasis on the indications, technical key points, and outcome differences of various surgical approaches and repair methods. It further discusses strategies for individualized procedure selection, in order to provide a reference for standardized clinical diagnosis and treatment.