Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2022 Nov;24(11):1285-1294.
doi: 10.1111/codi.16224. Epub 2022 Jul 6.

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

Sarah Sharabiany  1 , Thomas P A Brouwer  1 , Saskia I Kreisel  1 , Gijsbert D Musters  1 , Robin D Blok  1 , Roel Hompes  1   2 , Pieter J Tanis  2   3
Affiliations
Meta-Analysis

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

Sarah Sharabiany et al. Colorectal Dis. 2022 Nov.

Abstract

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.

Keywords: abdominoperineal resection; flap; mesh; perineal hernia repair.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Flow diagram demonstrating the course of inclusion and exclusion of papers
FIGURE 2
FIGURE 2
Forest plot showing the effect of type of perineal hernia repair (biological mesh, synthetic mesh, tissue flap only and tissue flap + mesh) on the risk of recurrence of perineal hernia
See this image and copyright information in PMC

References

    1. Musters GD, Klaver CEL, Bosker RJI, Burger JWA, van Duijvendijk P, van Etten B, et al. Biological mesh closure of the pelvic floor after extralevator abdominoperineal resection for rectal cancer: a multicenter randomized controlled trial (the BIOPEX‐study). Ann Surg. 2017;265(6):1074–81. - PubMed
    1. Habr‐Gama A, São Julião GP, Mattacheo A, de Campos‐Lobato LF, Aleman E, Vailati BB, et al. Extralevator abdominal perineal excision versus standard abdominal perineal excision: impact on quality of the resected specimen and postoperative morbidity. World J Surg. 2017;41(8):2160–7. - PubMed
    1. Sayers AE, Patel RK, Hunter IA. Perineal hernia formation following extralevator abdominoperineal excision. Colorectal Dis. 2015;17(4):351–5. - PubMed
    1. Tomohiro K, Tsurita G, Yazawa K, Shinozaki M. Ileal strangulation by a secondary perineal hernia after laparoscopic abdominoperineal rectal resection: a case report. Int J Surg Case Rep. 2017;33:107–11. - PMC - PubMed
    1. Kakiuchi D, Saito K, Mitsui T, Munemoto Y, Takashima Y, Amaya S, et al. Laparoscopic repair of a large perineal hernia after laparoscopic abdominoperineal resection: a case report. Asian J Endosc Surg. 2019;12(2):204–6. - PubMed