Incidence of incisional hernia high after colorectal surgery independent of suture technique

A new study published in the British Journal of Surgery found incisional hernia is common following colorectal cancer surgery. At 1 or 2 years, there was no statistically significant difference in the incidence of Hughes closure vs mass closure.

Incisional hernias cause morbidity and may necessitate further surgery. HART (Hughes Abdominal Repair Trial) tested the impact of a different suture procedure on the occurrence of incisional hernia after colorectal cancer surgery. As a result, the purpose of this study was to compare the use of the Hughes closure vs traditional mass closure for closure of midline abdominal wall incisions in patients following colon cancer surgery.

Patients undergoing midline incision for colorectal cancer were randomly assigned to either the Hughes closure (two 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 in a pragmatic multicenter single-blind RCT. The primary outcome was the clinical examination-based incidence of incisional hernia at 1 year. Intention-to-treat analysis was carried out.

The key findings of this study were:

1. Between August 2014 and February 2018, 802 patients were randomly assigned to one of two groups: Hughes closure (401) or conventional mass closure (401).

2. The primary outcome study comprised 672 patients (83.7%) one year after surgery; 50 of 339 patients (14.8%) in the Hughes group and 57 of 333 (17.1%) in the conventional closure group had incisional hernia.

3. At 2 years, 78 patients in the Hughes repair group (28.7%) and 84 (31.8%) in the conventional closure group had incisional hernia.

4. Except for the risk of surgical-site infection, which was greater in the Hughes group, all other adverse events were comparable in the two groups.

In conclusion, prophylactic mesh augmentation is anticipated to be the next focus of incisional hernia prevention research. The HULC study is presently recruiting participants to investigate the role of small-bite closure in conjunction with mesh insertion in elective midline laparotomies. Future studies should look at the function of prehabilitation in the prevention of incisional hernias.

Reference: 

HART Collaborative, Incisional hernia following colorectal cancer surgery according to suture technique: Hughes Abdominal Repair Randomized Trial (HART), British Journal of Surgery, Volume 109, Issue 10, October 2022, Pages 943–950, https://doi.org/10.1093/bjs/znac198