Aim <p>Despite the&#xa0;potential benefits of abdominoperineal pull-through with delayed coloanal anastomosis (DCAA), it is still infrequently performed as a salvage procedure for pelvic anastomotic failure. We aimed to perform a systematic review on the subject to guide practice.</p> Method <p>PubMed, Embase and Cochrane were used to identify studies evaluating DCAA for salvage after pelvic surgery from inception to August 2024. Risk of bias assessment was performed using the Newcastle-Ottawa scale. The primary outcome was overall stoma-free survival. Secondary outcomes included hospital length of stay, high-grade postoperative complication rates, 30-day postoperative mortality rates, incidence of redo surgical intervention after DCAA, and postoperative anorectal function.</p> Results <p>Five retrospective cohort studies evaluating a total of 97 patients&#xa0;who underwent salvage abdominoperineal pull-through and DCAA were included in this review. All patients had previous pelvic surgery, predominantly proctectomy (<i>n</i> = 84, 86.6%). The most common indication for&#xa0;redo surgery was chronic fistula (<i>n</i> = 62, 63.9%) followed by anastomotic leak or chronic pelvic sepsis (<i>n</i> = 34, 35.1%). The pooled overall stoma-free survival rate across all five studies was 81.4% over a mean 24-month postoperative follow-up duration. The overall incidence of high-grade complications&#xa0;after DCAA was 39.1% (<i>n</i> = 38). Pooled mean length of stay was 17 days. There were no cases of early postoperative death. Pooled rate of repeat surgery across four studies was 11.6% (<i>n</i> = 8). Pooled mean functional scores across three studies indicated minor low anterior resection syndrome at 26 months.</p> Conclusion <p>Abdominoperineal pull-through with delayed coloanal anastomosis is a viable option for salvage surgery following pelvic anastomotic complications, with low rates of permanent stoma and acceptable long-term anorectal function.</p>