Mesh, flap or combined repair of perineal hernia after abdominoperineal resection – A systematic review and meta-analysis

Aim: The aim of this systematic review was to analyse recurrence rates after different surgical techniques for perineal hernia repair. Method: All original studies (n ≥ 2 patients) reporting recurrence rates after perineal hernia repair after abdominoperineal resection (APR) were included. The electronic database PubMed was last searched in December 2021. The primary outcome was recurrent perineal hernia. A weighted average of the logit proportions was determined by the use of the generic inverse variance method and random effects model. Results: A total of 19 studies involving 172 patients were included. The mean age of patients was 64 ± 5.6 years and the indication for APR was predominantly cancer (99%, 170/172). The pooled percentage of recurrent perineal hernia was 39% (95% CI: 27%–52%) after biological mesh closure, 29% (95% CI: 21%–39%) after synthetic mesh closure, 37% (95% CI: 14%–67%) after tissue flap reconstruction only and 9% (95% CI: 1%–45%) after tissue flap reconstruction combined with mesh. Conclusion: Recurrence rates after mesh repair of perineal hernia are high, without a clear difference between biological and synthetic meshes. The addition of a tissue flap to mesh repair seemed to have a favourable outcome, which warrants further investigation.