Incisional hernia following colorectal cancer surgery according to suture technique: Hughes Abdominal Repair Randomized Trial (HART)

Abstract

Background Incisional hernias cause morbidity and may require further surgery. HART (Hughes Abdominal Repair Trial) assessed the effect of an alternative suture method on the incidence of incisional hernia following colorectal cancer surgery. Methods A pragmatic multicentre single-blind RCT allocated patients undergoing midline incision for colorectal cancer to either Hughes closure (double far–near–near–far sutures of 1 nylon suture at 2-cm intervals along the fascia combined with conventional mass closure) or the surgeon’s standard closure. The primary outcome was the incidence of incisional hernia at 1 year assessed by clinical examination. An intention-to-treat analysis was performed. Results Between August 2014 and February 2018, 802 patients were randomized to either Hughes closure (401) or the standard mass closure group (401). At 1 year after surgery, 672 patients (83.7 per cent) were included in the primary outcome analysis; 50 of 339 patients (14.8 per cent) in the Hughes group and 57 of 333 (17.1 per cent) in the standard closure group had incisional hernia (OR 0.84, 95 per cent c.i. 0.55 to 1.27; P = 0.402). At 2 years, 78 patients (28.7 per cent) in the Hughes repair group and 84 (31.8 per cent) in the standard closure group had incisional hernia (OR 0.86, 0.59 to 1.25; P = 0.429). Adverse events were similar in the two groups, apart from the rate of surgical-site infection, which was higher in the Hughes group (13.2 versus 7.7 per cent; OR 1.82, 1.14 to 2.91; P = 0.011). Conclusion The incidence of incisional hernia after colorectal cancer surgery is high. There was no statistical difference in incidence between Hughes closure and mass closure at 1 or 2 years. Registration number ISRCTN25616490 (http://www.controlled-trials.com).

Low incisional hernia incidence using a large-bite, low-tension technique for celiotomy closure

“…This study found a low IH rate of 3.3 % in patients undergoing abdominal operations primarily for a malignancy. Other studies which were performed in cancer patients have reported hernia formation rates of 6.0–41 % ( 6 , 7 , [12] , [13] , [14] ). In 2016, Baucom et al reported that factors independently associated with hernia formation included midline, periumbilical, and subcostal incisions, laparoscopic-assisted procedure, increasing BMI, postoperative surgical site infection (SSI), and a cancer diagnosis other than colorectal or urologic/gynecologic malignancy ( 7 ).…”

Occurrence and prevention of incisional hernia following laparoscopic colorectal surgery

“…Partial fascial closure techniques may increase the risk of postoperative abdominal wall hernia[ 31 ]. Hughes abdominal closure experiments have initially shown promise in reducing the risk of IH[ 48 , 49 ], but further clinical validation is still required[ 50 ]. Compared to traditional continuous suturing with large bite stitching techniques, the small bite technique has been shown to lower the high risk of IH at midline incisions.…”

Incidence, Healthcare Resource Use and Costs Associated With Incisional Hernia Repair

“…Incisional hernia (IH) is a common complication of abdominal surgery, affecting 12.8%-30% of patients [1,2]. Risk factors for developing IH include, but are not limited to, increasing age, obesity, smoking, location of surgical incision, suture material and closure technique [1,[3][4][5][6].…”