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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

British Journal of Surgery, Volume: 109, Issue: 10, Pages: 943 - 950

Swansea University Authors: Angela Farr Orcid Logo, Berni Sewell

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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
first_indexed 2022-08-16T13:04:13Z
last_indexed 2023-01-13T19:21:15Z
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spelling 2023-01-04T15:12:03.5268563 v2 60828 2022-08-16 Incisional hernia following colorectal cancer surgery according to suture technique: Hughes Abdominal Repair Randomized Trial (HART) ab00dbaa888f32b41b07ef223d0e2987 0000-0002-2087-9310 Angela Farr Angela Farr true false f6a4af2cfa4275d2a8ebba292fa14421 Berni Sewell Berni Sewell true false 2022-08-16 HSOC 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). Journal Article British Journal of Surgery 109 10 943 950 Oxford University Press 8 8 2022 2022-08-08 10.1093/bjs/znac198 https://academic.oup.com/bjs/advance-article/doi/10.1093/bjs/znac198/6656065?searchresult=1 COLLEGE NANME Health and Social Care School COLLEGE CODE HSOC Swansea University Other The study received Health Technology Assessment funding from the National Institute for Health Research (NIHR). 2023-01-04T15:12:03.5268563 2022-08-16T13:51:12.8806251 Faculty of Medicine, Health and Life Sciences School of Health and Social Care Angela Farr 0000-0002-2087-9310 1 Berni Sewell 2 60828__24992__9bd8990b66534cb1b862cf329e5d186e.pdf 60828_VoR.pdf 2022-08-23T11:57:04.9167253 Output 593704 application/pdf Version of Record true © The Author(s) 2022. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License true eng https://creativecommons.org/licenses/by-nc/4.0/
title Incisional hernia following colorectal cancer surgery according to suture technique: Hughes Abdominal Repair Randomized Trial (HART)
spellingShingle Incisional hernia following colorectal cancer surgery according to suture technique: Hughes Abdominal Repair Randomized Trial (HART)
Angela Farr
Berni Sewell
title_short Incisional hernia following colorectal cancer surgery according to suture technique: Hughes Abdominal Repair Randomized Trial (HART)
title_full Incisional hernia following colorectal cancer surgery according to suture technique: Hughes Abdominal Repair Randomized Trial (HART)
title_fullStr Incisional hernia following colorectal cancer surgery according to suture technique: Hughes Abdominal Repair Randomized Trial (HART)
title_full_unstemmed Incisional hernia following colorectal cancer surgery according to suture technique: Hughes Abdominal Repair Randomized Trial (HART)
title_sort Incisional hernia following colorectal cancer surgery according to suture technique: Hughes Abdominal Repair Randomized Trial (HART)
author_id_str_mv ab00dbaa888f32b41b07ef223d0e2987
f6a4af2cfa4275d2a8ebba292fa14421
author_id_fullname_str_mv ab00dbaa888f32b41b07ef223d0e2987_***_Angela Farr
f6a4af2cfa4275d2a8ebba292fa14421_***_Berni Sewell
author Angela Farr
Berni Sewell
author2 Angela Farr
Berni Sewell
format Journal article
container_title British Journal of Surgery
container_volume 109
container_issue 10
container_start_page 943
publishDate 2022
institution Swansea University
doi_str_mv 10.1093/bjs/znac198
publisher Oxford University Press
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str School of Health and Social Care{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}School of Health and Social Care
url https://academic.oup.com/bjs/advance-article/doi/10.1093/bjs/znac198/6656065?searchresult=1
document_store_str 1
active_str 0
description 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).
published_date 2022-08-08T14:17:24Z
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