Hughes' abdominal closure fails to reduce incident incisional hernia in patients with colorectal cancer

Hughes' abdominal closure does not significantly reduce the incidence of laboratory-detected incisional hernias and is more cost-effective than standard mass closure in patients with colorectal cancer, says an article published in the National Institutes of Health and Care Research.

Incisional hernias can cause chronic pain and complications and affect quality of life. Surgical repair requires medical resources and has significant failure rates associated with it. Susan O'Connell and her team therefore conducted this study to evaluate the efficacy of the Hughes abdominal closure compared to standard mass closure for relieving incisional hernias after colorectal cancer surgery.

In this multicenter, prospective, single-blind, randomized, controlled study, investigators evaluated the clinical efficacy of the Hughes abdominal closure technique compared with standard mass closure after surgery for colorectal cancer, as well as the cost-effectiveness of both the techniques.

In this study, 802 adult patients (18 years and older) undergoing surgical resection for colorectal cancer from 28 surgical departments of the UK Center were randomized in a 1:1 ratio. Hughes abdominal closure or standard mass closure were the main inclusion criteria for this study.

The primary endpoint was the 1-year incidence of incisional hernia as assessed by clinical evaluation. A cost-effectiveness and cost-benefit analysis were conducted over a one-year period in terms of NHS and social care. The key secondary endpoint was quality of life, and additional endpoints included the incidence of incisional hernias detected by computed tomography scans.

The main results of this study were:

1. The incidence of incisional hernia at his first year of clinical evaluation was 50 (14.8%) with the Hughes open arm compared with 57 (17.1%) with the standard mass closure arm.

2. The incidence of incisional hernia at 2 years was 78 (28.7%) with the Hughes abdominal closed arm compared to 84 (31.8%) with the standard mass closure arm.

3. Computed tomography scans identified a total of 301 incisional hernias in both arms compared with 100 identified by clinical examination at 1-year follow-up.

4. Computed tomography missed 16 incisional hernias found on clinical examination.

5. The Hughes abdominal closure was found to be less cost effective than the standard bulk closure.

6. The average additional cost for patients undergoing Hughes abdominal closure was £616.45.

7. Quality of life did not differ significantly between study groups at any time point.

Computed tomography scans may be more effective than clinical examination in identifying incisional hernias, but their clinical utility requires further research, concluded the Authors.

Reference: 

O'Connell, S., Islam, S., Sewell, B., Farr, A., Knight, L., Bashir, N., Harries, R., Jones, S., Cleves, A., Fegan, G., Watkins, A., & Torkington, J. (2022). Hughes abdominal closure versus standard mass closure to reduce incisional hernias following surgery for colorectal cancer: the HART RCT. In Health Technology Assessment (Vol. 26, Issue 34, pp. 1–100). National Institute for Health and Care Research (NIHR). https://doi.org/10.3310/cmwc8368