Biological mesh closure helps reduce perineal hernia after abdominoperineal resection: Study

Netherlands: A recent study has shown that the rate of symptomatic perineal hernia following abdominoperineal resection for rectal cancer was much reduced after biological mesh closure at a 5-year follow-up. Closure with biological mesh had no effect on the quality of life or functional results. The findings of this work were published in Annals of Surgery, January 2022 volume.

Cancer is one of the most prevalent ailments in developed nations with aging populations, in terms of both public welfare and health measures. Surgical site infection (SSI) is a frequent complication in CRC surgery, and many techniques have been tried to reduce its occurrence. Perineal wound complications, such as open perineal wound infections, continue to be serious clinical issues, particularly following abdominoperineal resection.

This study was conducted by Robin D. Blok and the team with the objective to compare the long-term results of primary perineal closure and biological mesh in rectal cancer patients after extralevator abdominoperineal resection and prior radiation, with a primary focus on symptomatic perineal hernia (BIOPEX). BIOPEX is the first randomized experiment in this discipline that failed to achieve its primary aim (30-day wound healing). 

This was a posthoc secondary study of patients who had been randomly assigned to either biological mesh closure (n = 50; 2 dropouts) or primary perineal closure (n = 54; 1 dropout) in the BIOPEX trial. Patients were monitored for a period of five years. The Kaplan-Meier statistic was used to calculate actuarial 5-year probability.

The results of this study stated as follow:

1. Actuarial 5-year symptomatic perineal hernia rates following biological mesh closure were 7% vs 30% after primary closure.

2. One patient (2%) in the biomesh group had elective perineal hernia repair, compared to seven patients (13%) in the primary closure group.

3. Reoperations for small bowel blockage were required in 1/48 (2%) and 5/53 (9%) patients, respectively.

4. There were no statistically significant differences in chronic perineal wound issues, locoregional recurrence, overall survival, or the key categories of quality of life and functional outcome.

Reference:

Blok, Robin D. MD et. al. Cumulative 5-year Results of a Randomized Controlled Trial Comparing Biological Mesh With Primary Perineal Wound Closure After Extralevator Abdominoperineal Resection (BIOPEX-study), Annals of Surgery: January 2022, doi:10.1097/SLA.0000000000004763