Incisional hernia following colorectal cancer surgery according to suture technique: Hughes Abdominal Repair Randomized Trial (HART)
HART Collaborative, Jared Torkington, Rhiannon Harries, Susan O’Çonnell, Laura Knight, Saiful Islam, Nadim Bashir, Alan Watkins, Greg Fegan, Julie Cornish, B I Rees, Hannah Cole, Hannah Jarvis, Stefanie A Jones, Ian Russell, David C. Bosanquet, Anne Cleves, Bernadette Sewell, Angela Farr, N Zbrzyzna, N Fiera, Rwth Ellis‐Owen, N. Zoe Hilton, Chris M. Parry, Andrew W. Bradbury, Peter Wall, James Hill, D. C. Winter, Kim Cocks, Dean Harris, J. Hilton, Stelios Vakis, D. Hanratty, R. Rajagopal, F. Akbar, A Ben-Sassi, Nader Francis, Louise Jones, M. E. R. Williamson, Ian Lindsey, Robert West, Christopher J. Smart, Paul Ziprin, Tulika Mehta Agarwal, G Faulkner, Thomas Pinkney, Dale Vimalachandran, D Lawes, Omar Faiz, Pasha J. Nisar, Neil Smart, Tim Wilson, Angela Myers, Jonathan N. Lund, Sebastian Smolarek, Austin G. Acheson, James Horwood, James Ansell, Simon Phillips, Matthew L. Davies, Linda Davies, Shawn J. Bird, N Palmer, Michael L. Williams, Giorgios Galanopoulos, Pryangka Rao, D Jones, Rebecca E. Barnett, Sophia Tate, J Wheat, Neil Patel, Shaghayegh Rahmani, E Toynton, Laurie Smith, Nicola Reeves, E Kealaher, G Williams, C Sekaran, Mary Evans, J Beynon, Richard Egan, Ebtisam R Qasem, U Khot, Sarim Ather, P Mummigati, Graham W. Taylor, J Williamson, J Lim, Anathea C. Powell, H Nageswaran, A. Williams, J Padmanabhan, Katherine W. Phillips, Tamsin Ford, John Edwards, Nils R. Varney, Lucy Hicks, C. V. Greenway, Karen Chesters, Helen M.F. Jones
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).