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).
Publication Date
2022-09-09
Publication Title
British Journal of Surgery
Volume
109
Issue
10
ISSN
0007-1323
Embargo Period
2023-02-09
First Page
943
Last Page
950
Recommended Citation
Torkington, J., Harries, R., O'Connell, S., Knight, L., Islam, S., Bashir, N., Watkins, A., Fegan, G., Cornish, J., Rees, B., Cole, H., Jarvis, H., Jones, S., Russell, I., Bosanquet, D., Cleves, A., Sewell, B., Farr, A., Zbrzyzna, N., Fiera, N., Ellis-Owen, R., Hilton, Z., Parry, C., Bradbury, A., Wall, P., Hill, J., Winter, D., Cocks, K., Harris, D., & Hilton, J. (2022) 'Incisional hernia following colorectal cancer surgery according to suture technique: Hughes Abdominal Repair Randomized Trial (HART)', British Journal of Surgery, 109(10), pp. 943-950. Available at: 10.1093/bjs/znac198" >https://doi.org/10.1093/bjs/znac198
