Hughes Abdominal Repair Trial (HART) – Abdominal wall closure techniques to reduce the incidence of incisional hernias: study protocol for a randomised controlled trial

Cornish, Julie; Harries, Rhiannon L; Bosanquet, David C.; Rees, B.; Ansell, James; Frewer, Natasha; Rao, Pawan Kumar Dhruva; Parry, Craig; Ellis-Owen, R.; Phillips, Simon; Morris, C.G.; Horwood, James; Davies, Mark; Hargest, Rachel; Davies, Zoe G.; Hilton, Joanna; Harris, Dean; Ben-Sassi, Abozed; Ramesh, Rajagopal; Hanratty, D.; Islam, Saiful; Watkins, Alan; Bashir, Nadim; Jones, Siân; Russell, Ian; Torkington, Jared

doi:10.1186/s13063-016-1573-0

Cited by 21 publications

(16 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, the clinical significance of occult hernias remains unknown. No matter the reasoning, our detected high rate of radiographic hernias does align with some prior studies (20, 21). A study utilizing high- resolution ultrasound, for example, to determine the prevalence of paraumbilical hernias among adult patients in a tertiary care hospital presenting for non-abdominal wall complaints detected an approximately 25% rate (22).…”

Section: Discussionsupporting

confidence: 92%

External Validation of the HERNIAscore: An Observational Study

Cherla

Moses

Mueck

et al. 2017

Journal of the American College of Surgeons

View full text Add to dashboard Cite

Background The HERNIAscore is a ventral incisional hernia (VIH) risk assessment tool that utilizes only preoperative variables and predictable intraoperative variables. The aim of this study was to validate and modify, if needed, the HERNIAscore in an external dataset. Study Design This was a retrospective observational study of all patients undergoing resection for gastrointestinal malignancy 2011–2015 at a safety-net hospital. Primary outcome was clinical postoperative VIH. Patients were stratified into low, medium, and high risk based on HERNIAscore. A Revised HERNIAscore was formed with the addition of prior abdominal surgery as a categorical variable. Cox regression of incisional hernia with stratification by risk class was performed. Incidence rates of clinical VIH formation within each risk class were also calculated. Results 247 patents were enrolled. On Cox regression, in addition to the three variables of the HERNIAscore (BMI, incision length, and COPD), prior abdominal surgery was also predictive of VIH. The Revised HERNIAscore demonstrated improved predictive accuracy for clinical VIH. While the original HERNIAscore effectively stratified the risk of developing an incisional radiographic VIH, the Revised HERNIAscore provided a statistically significant stratification for both clinical and radiographic VIHs in this patient cohort. Conclusion We have externally validated and improved the HERNIAscore. The Revised HERNIAscore utilizes BMI, incision length, COPD, and prior abdominal surgery to predict risk of post-operative incisional hernia. Future research should assess methods to prevent incisional hernias in moderate-to-high risk patients.

show abstract

Section: Discussionsupporting

confidence: 92%

External Validation of the HERNIAscore: An Observational Study

Cherla

Moses

Mueck

et al. 2017

Journal of the American College of Surgeons

View full text Add to dashboard Cite

show abstract

“…12 Similarly, another RCT (HART Trial) in Wales, UK, is underway, which is designed to compare the Cardiff suture technique (far-near-near-far) with standard mass closure to assess the incidence of IH. 13 This paper has highlighted the current practice of surgical treatment of IH and the ongoing research studies designed to establish the most effective method for prevention of IH. It is evident that IH is a major problem after abdominal surgery and no single currently available method of repair is satisfactory.…”

Section: Incisional Hernia Repair: Current Perspectivesmentioning

confidence: 99%

Incisional hernia repair: Current perepectives

Shrestha

2017

J Nepal Med Assoc

View full text Add to dashboard Cite

Incisional hernia (IH) is a common and challenging problem after midline laparotomy and other operations on the anterior abdominal wall. It is estimated that 10000 patients in the United Kingdom and 100000 in the United States of America undergo IH repair annually. The incidence of IH ranges from 10-38%, which causes deterioration in the quality of life from pain, disability, dissatisfaction, risk of strangulation and high costs. 1 Despite significant advances in the methods of repair of IH, including prophylactic repairs, the incidence of recurrence after repair of IH remains unacceptable (12-24%), and those who experience recurrence, pose greater technical challenges with increased risk of recurrence and morbidity.Obesity, smoking, diabetes, immunosuppression (organ transplantation, rheumatoid arthritis, malignancies), wound infection and defective collagen metabolism (abdominal aortic aneurysm) are risk factors for IH. 2 The aim of this paper is to overview the outcomes of different modalities of repair IH repair, including suture vs. mesh, open vs. laparoscopic, location of the mesh (onlay, sublay and inlay), prophylactic repairs and ongoing trials.Classically, IH is repaired by approximating the anatomical layers around the defect with both absorbable or non-absorbable suture materials with a recurrence rate of 12-54%, whereas open mesh repair (onlay, sublay and inlay) results in recurrence rate of 2-36%.In 1980, Jenkins from UK, repaired IH by performing mass closure of the wound using nonabsorbable double-stranded nylon suture with the length of the suture being 4 times the length of the wound and placed the sutures not more than 0.5 cm apart and 2.5 cm from the edge of the wound. He observed 10% recurrence rate. 3 A randomised trial comparing IH repair using absorbable polydioxanone and non-absorbable polypropylene sutures did not show difference in the outcomes. 4The European Hernia Society has adopted sublay mesh repair as the gold standard open method of IH repair because of low recurrence rate, where the mesh placed is over the closed peritoneum and posterior rectus sheath,. 5 It is now accepted that only IH with smaller than 3cm defects should be repaired by primary tissue approximation with sutures. A Cochrane review has confirmed that open mesh repair is superior to suture repair in terms of recurrence, but inferior in terms of wound infection and seroma formation. 6Laparoscopic IH repair has emerged as a promising technique which allows visualisation of all defects from within, but has the disadvantage that the repair relies fully on the strength of the mesh and its fixation to abdominal wall. In this technique, a composite mesh is placed in the intraperitoneal plane, known as intraperitoneal onlay mesh (IPOM), and the hernia defect is not closed. Laparoscopic repair is not always possible in large IH, those lying close

show abstract

“…The use of so‐called near and far (Hughes) stitches has also been described, but it too has not become common practice. However, the Hughes Abdominal Repair Trial (HART) is busy recruiting from centres throughout the UK, and its results are awaited. Both arms of this trial use continuous large‐bite, large‐stitch mass closure of the midline, with the study arm also incorporating a series of horizontal and two vertical mattress sutures within a single non‐absorbable suture to the linea alba.…”

mentioning

confidence: 99%