Perineal hernia repair: multicentre comparative analysis of synthetic mesh versus mesh combined with tissue flap

Abstract Aim Surgical techniques for perineal hernia repair have evolved over time. Presently, synthetic mesh repair is the preferred technique, but recurrence rates are high. This study aimed to compare the outcomes of adding a tissue flap to the mesh with mesh-only repair. Method Between 2006 and 2022, patients who underwent perineal hernia repair with synthetic mesh or mesh combined with tissue flap were retrospectively identified from three referral centres. Primary endpoint was recurrent perineal hernia. Results Seventy-nine patients were included, of which 65 patients underwent mesh-only repair and 14 patients mesh with flap repair. Postoperative perineal wound complications occurred in 23% in the mesh-only group and in 21% in the mesh with flap group. Meshes were solely explanted within the mesh-only group (n = 3). There were no flap failures in the mesh with flap group. During a median follow-up of 54 months, recurrent perineal hernia occured in 27/65 (42%) after mesh-only and in 2/14 (14%) after mesh with flap repair (p = 0.06). Time to recurrent hernia was median 14 months. Failed mesh only repair was successfully treated by crossover to mesh with flap in 4/4 patients. Conclusion Mesh combined with tissue flap repair of a perineal hernia seems more effective than synthetic mesh-only repair. These findings have to be confirmed in larger series.