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



Torkington, J, Harries, R, O'Connell, S, Knight, L, Islam, S, Bashir, N, Watkins, A, Fegan, G, Cornish, J, Rees, B
et al (show 222 more authors) (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.

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Abstract

<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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).<h4>Conclusion</h4>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.<h4>Registration number</h4>ISRCTN25616490 (http://www.controlled-trials.com).

Item Type: Article
Uncontrolled Keywords: HART Collaborative, Humans, Colorectal Neoplasms, Nylons, Suture Techniques, Single-Blind Method, Sutures, Abdominal Wound Closure Techniques, Incisional Hernia
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Institute of Systems, Molecular and Integrative Biology
Depositing User: Symplectic Admin
Date Deposited: 31 Jan 2024 11:50
Last Modified: 31 Jan 2024 11:50
DOI: 10.1093/bjs/znac198
Open Access URL: https://doi.org/10.1093/bjs/znac198
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URI: https://livrepository.liverpool.ac.uk/id/eprint/3178201