Results
After screening 14,197 records, 35 met the inclusion criteria and were included in the review. These studies comprised 4,902 patients, predominantly male (97.9%), with a mean age of 57.2 years. Six studies compared posterior versus anterior repair after prior anterior repair. Recurrence was assessed in six studies (869 patients; 63 events), with no statistically significant difference between approaches (OR 0.70, 95% CI 0.39-1.27; I²=7.5%). Chronic postoperative pain was assessed in five studies (722 patients; 92 events), with no statistically significant difference in the primary analysis (OR 0.47, 95% CI 0.22-1.00; I²=52.7%), although posterior repair was associated with significantly lower odds in the RCT-only sensitivity analysis (OR 0.36, 95% CI 0.16-0.81; I²=44.1%). SSI was assessed in five studies (604 patients; 14 events), with significantly lower odds following posterior repair (OR 0.24, 95% CI 0.07-0.79; I²=0%). Seroma was assessed in three studies (386 patients; 15 events), with no significant difference between approaches (OR 0.77, 95% CI 0.26-2.29; I²=0%). Among studies evaluating posterior repair after prior anterior repair, recurrence was assessed in seventeen studies (3,551 patients; 59 events), with a pooled rate of 2% (95% CI 0.01-0.03; I²=16.5%); chronic postoperative pain in fifteen studies (3,396 patients; 137 events), with a pooled rate of 3% (95% CI 0.01-0.06; I²=65.3%); SSI in fifteen studies (3,370 patients; 25 events), with a pooled rate of 1% (95% CI 0.00-0.02; I²=76.3%); and seroma in fourteen studies (3,339 patients; 110 events), with a pooled rate of 5% (95% CI 0.03-0.07; I²=74.5%). Among studies evaluating posterior re-repair after prior posterior repair, recurrence was assessed in eleven studies (316 patients; 8 events), with a pooled rate of 1% (95% CI 0.00-0.06; I²=0%); chronic postoperative pain in eight studies (224 patients; 19 events), with a pooled rate of 6% (95% CI 0.02-0.15; I²=0%); SSI in seven studies (231 patients; 3 events), with a pooled rate of 1% (95% CI 0.00-0.04; I²=0%); and seroma in eleven studies (316 patients; 21 events), with a pooled rate of 6% (95% CI 0.03-0.12; I²=34.8%). Only one study evaluated anterior repair following prior posterior repair, precluding quantitative synthesis.
