Aim There is little evidence concerning the optimal surgical technique for the repair of perineal hernia. This study aimed to report on the evolution of a technique for repair of perineal hernia by analysing the experience in a tertiary referral centre. Method This was a retrospective review of consecutive patients who underwent perineal hernia repair after abdominoperineal excision in a tertiary referral centre. The main study end‐points were rate of recurrent perineal hernia, perineal wound complications and related re‐intervention. Results Thirty‐four patients were included: in 18 patients a biological mesh was used followed by 16 patients who underwent synthetic mesh repair. Postoperative perineal wound infection occurred in two patients (11%) after biological mesh repair compared with four (25%) after synthetic mesh repair (P = 0.387). None of the meshes were explanted. Recurrent perineal hernia following biological mesh was found in 7 of 18 patients (39%) after a median of 33 months. The recurrence rate with a synthetic mesh was 5 of 16 patients (31%) after a median of 17 months (P = 0.642). Re‐repair was performed in four (22%) and two patients (13%), respectively (P = 0.660). Eight patients required a transposition flap reconstruction to close the perineum over the mesh, and no recurrent hernias were observed in this subgroup (P = 0.030). No mesh‐related small bowel complications occurred. Conclusion Recurrence rates after perineal hernia repair following abdominoperineal excision were high, and did not seem to be related to the type of mesh. If a transposition flap was added to the mesh repair no recurrences were observed, but this finding needs confirmation in larger studies.

Perineal hernia after abdominoperineal resection (APR) remains a vexing problem for both patients and clinicians. In the current literature the incidence of symptomatic perineal hernia ranges from 7% to 30% [1-3]. A perineal hernia may cause discomfort, pain, wound healing problems, urogenital dysfunction and small bowel obstruction [4][5][6]. Depending on the severity of symptoms, preference and experience of the surgeon, an elective repair is sometimes considered. In contrast to abdominal wall hernias, literature on perineal hernia repair is very limited.Recurrence rates after surgical repair of a perineal hernia are high, and no consensus has been reached regarding the preferred method. Many options have been described, including primary