Design and current status of CONTINT: continuous versus interrupted abdominal wall closure after emergency midline laparotomy - a randomized controlled multicenter trial [NCT00544583]

Rahbari, Nuh N.; Knebel, Phillip; Kieser, Meinhard; Brückner, Thomas; Bartsch, Detlef K.; Frieß, Helmut; Mihaljevic, André L.; Stern, J.; Voss, Sabine; Rossion, Inga; Büchler, Markus W.; Seiler, Christoph M.

doi:10.1186/1745-6215-13-72

Cited by 15 publications

(17 citation statements)

References 22 publications

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“…They found a reduction from 21 % (large-bite) to 13 % (small-bite) in the rate of IHs at 1 year. The CONTinuous versus INTerrupted abdominal wall closure after emergency midline laparotomy (CONTINT) RCT, still recruiting, is comparing continuous with interrupted sutures in closing midline incisions after emergency laparotomy [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

Hughes Abdominal Repair Trial (HART) – Abdominal wall closure techniques to reduce the incidence of incisional hernias: study protocol for a randomised controlled trial

Cornish

Harries

Bosanquet

et al. 2016

Trials

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BackgroundIncisional hernias are common complications of midline closure following abdominal surgery and cause significant morbidity, impaired quality of life and increased health care costs.The ‘Hughes Repair’ combines a standard mass closure with a series of horizontal and two vertical mattress sutures within a single suture. This theoretically distributes the load along the incision length as well as across it. There is evidence to suggest that this technique is as effective as mesh repair for the operative management of incisional hernias; however, no trials have compared the Hughes Repair with standard mass closure for the prevention of incisional hernia formation following a midline incision.Methods/designThis is a 1:1 randomised controlled trial comparing two suture techniques for the closure of the midline abdominal wound following surgery for colorectal cancer. Full ethical approval has been gained (Wales REC 3, MREC 12/WA/0374). Eight hundred patients will be randomised from approximately 20 general surgical units within the United Kingdom. Patients undergoing open or laparoscopic (more than a 5-cm midline incision) surgery for colorectal cancer, elective or emergency, are eligible. Patients under the age of 18 years, those having mesh inserted or undergoing musculofascial flap closure of the perineal defect in abdominoperineal wound closure, and those unable to give informed consent will be excluded. Patients will be randomised intraoperatively to either the Hughes Repair or standard mass closure. The primary outcome measure is the incidence of incisional hernias at 1 year as assessed by standardised clinical examination. The secondary outcomes include quality of life patient-reported outcome measures, cost-utility analysis, incidence of complete abdominal wound dehiscence and C-POSSUM scores. The incidence of incisional hernia at 1 year, assessed by computerised tomography, will form a tertiary outcome.DiscussionA feasibility phase has been completed. The results of the study will be used to inform current and future practice and potentially reduce the risk of incisional hernia formation following midline incisions.Trial registrationTrial Registration Number: ISRCTN 25616490. Registered on 1 January 2012.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-016-1573-0) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Hughes Abdominal Repair Trial (HART) – Abdominal wall closure techniques to reduce the incidence of incisional hernias: study protocol for a randomised controlled trial

Cornish

Harries

Bosanquet

et al. 2016

Trials

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“…3 This heterogeneity of behavior has led many authors to standardize abdominal wall closure procedures. 4,6 If the process of standardization has achieved satisfactory results in the elective surgery setting as demonstrated by recent international guidelines of the European hernia society with the introduction of globally accepted slowly absorbable running suture as gold standard for abdominal wall closure, shortage of solid evidence leaves the emergency setting an unexplored field. 5 Another controversial argument is represented by safer technique and material used for skin closure after contaminated/dirty abdominal surgery, present literature remains nowadays inconclusive and lacks strong evidences.…”

Section: Discussionmentioning

confidence: 99%

“…5 Trying to define the problem of abdominal wall closure after emergency surgery, Rahbari et al, designed the CONTINT study protocol (continuous versus interrupted abdominal wall closure after emergency midline laparotomy). 6 This RCT is still ongoing and results haven't been published yet.…”

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confidence: 99%

Searching for the safest abdominal closure technique after emergency laparotomy for Hinchey III and IV peritonitis

et al. 2017

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Background: The optimal strategy for abdominal wall closure has been an ongoing issue of debate and convincing evidence is still lacking. The INLINE systematic review and meta-analysis published on annals of surgery 2010 suggested that a running suture with a slowly absorbable suture material was the gold standard technique for abdominal wall closure after elective surgery, while there’s no general agreement in the emergency setting.Methods: Retrospective study regarding patients who underwent emergency surgery for a generalized peritonitis due to colonic perforation from 2002 to 2014 at San Gerardo hospital (Monza, Italy). Particularly study analyzed differences between continuous suture (Maxon loop, Covidien ©) and interrupted suture (Safil, B. Braun ©) for fascial closure and between metallic clips and second intention healing for incision management. After completion of data retrieval, 110 patients were included in the statistical analysis.Results: Incisional hernia rate was 15/101 (14.9%) and surgical site infection rate was 29/110 (26.4%). No significant statistical differences were found between incidence of incisional hernia and surgical site infection in the two groups, although there was a higher prevalence of incisional hernia in the running suture group (25% vs 11,7%). There was no difference between skin-stapler’s and second-intention’s wound closure groups in terms of surgical site infection and incisional hernia development.Conclusions: We consider reasonable to use an interrupted long time absorbable suture for fascial closure after emergency midline laparotomy for Hinchey III and IV peritonitis, at least in high-risk patients. Considering skin closure, suggestion is to perform a primary skin closure.

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“…11 In Germany, a RCT (CONTINT Trial) designed to assess the incidence if IH using continuous or interrupted suture techniques after emergency laparotomy, is recruiting patients. 12 Similarly, another RCT (HART Trial) in Wales, UK, is underway, which is designed to compare the Cardiff suture technique (far-near-near-far) with standard mass closure to assess the incidence of IH. 13 This paper has highlighted the current practice of surgical treatment of IH and the ongoing research studies designed to establish the most effective method for prevention of IH.…”

Section: Incisional Hernia Repair: Current Perspectivesmentioning

confidence: 99%

Incisional hernia repair: Current perepectives

Shrestha

2017

J Nepal Med Assoc

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Incisional hernia (IH) is a common and challenging problem after midline laparotomy and other operations on the anterior abdominal wall. It is estimated that 10000 patients in the United Kingdom and 100000 in the United States of America undergo IH repair annually. The incidence of IH ranges from 10-38%, which causes deterioration in the quality of life from pain, disability, dissatisfaction, risk of strangulation and high costs. 1 Despite significant advances in the methods of repair of IH, including prophylactic repairs, the incidence of recurrence after repair of IH remains unacceptable (12-24%), and those who experience recurrence, pose greater technical challenges with increased risk of recurrence and morbidity.Obesity, smoking, diabetes, immunosuppression (organ transplantation, rheumatoid arthritis, malignancies), wound infection and defective collagen metabolism (abdominal aortic aneurysm) are risk factors for IH. 2 The aim of this paper is to overview the outcomes of different modalities of repair IH repair, including suture vs. mesh, open vs. laparoscopic, location of the mesh (onlay, sublay and inlay), prophylactic repairs and ongoing trials.Classically, IH is repaired by approximating the anatomical layers around the defect with both absorbable or non-absorbable suture materials with a recurrence rate of 12-54%, whereas open mesh repair (onlay, sublay and inlay) results in recurrence rate of 2-36%.In 1980, Jenkins from UK, repaired IH by performing mass closure of the wound using nonabsorbable double-stranded nylon suture with the length of the suture being 4 times the length of the wound and placed the sutures not more than 0.5 cm apart and 2.5 cm from the edge of the wound. He observed 10% recurrence rate. 3 A randomised trial comparing IH repair using absorbable polydioxanone and non-absorbable polypropylene sutures did not show difference in the outcomes. 4The European Hernia Society has adopted sublay mesh repair as the gold standard open method of IH repair because of low recurrence rate, where the mesh placed is over the closed peritoneum and posterior rectus sheath,. 5 It is now accepted that only IH with smaller than 3cm defects should be repaired by primary tissue approximation with sutures. A Cochrane review has confirmed that open mesh repair is superior to suture repair in terms of recurrence, but inferior in terms of wound infection and seroma formation. 6Laparoscopic IH repair has emerged as a promising technique which allows visualisation of all defects from within, but has the disadvantage that the repair relies fully on the strength of the mesh and its fixation to abdominal wall. In this technique, a composite mesh is placed in the intraperitoneal plane, known as intraperitoneal onlay mesh (IPOM), and the hernia defect is not closed. Laparoscopic repair is not always possible in large IH, those lying close

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Design and current status of CONTINT: continuous versus interrupted abdominal wall closure after emergency midline laparotomy - a randomized controlled multicenter trial [NCT00544583]

Cited by 15 publications

References 22 publications

Hughes Abdominal Repair Trial (HART) – Abdominal wall closure techniques to reduce the incidence of incisional hernias: study protocol for a randomised controlled trial

Hughes Abdominal Repair Trial (HART) – Abdominal wall closure techniques to reduce the incidence of incisional hernias: study protocol for a randomised controlled trial

Searching for the safest abdominal closure technique after emergency laparotomy for Hinchey III and IV peritonitis

Incisional hernia repair: Current perepectives

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