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

Angela Farr Orcid Logo, Berni Sewell Orcid Logo

British Journal of Surgery

Swansea University Authors: Angela Farr Orcid Logo, Berni Sewell Orcid Logo

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DOI (Published version): 10.1093/bjs/znac198

Abstract

BackgroundIncisional 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.MethodsA pragmatic multicentre single-blind RCT allocated p...

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Published in: British Journal of Surgery
Published: Oxford University Press 2022
Online Access: https://academic.oup.com/bjs/advance-article/doi/10.1093/bjs/znac198/6656065?searchresult=1
URI: https://cronfa.swan.ac.uk/Record/cronfa60828
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Abstract: BackgroundIncisional 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.MethodsA 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.ResultsBetween 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).ConclusionThe 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 numberISRCTN25616490 (http://www.controlled-trials.com).
College: College of Human and Health Sciences
Funders: The study received Health Technology Assessment funding from the National Institute for Health Research (NIHR).