Br J Surg. 2022 Sep 9;109(10):943-950. doi: 10.1093/bjs/znac198.
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.
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.
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).
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.
ISRCTN25616490 (http://www.controlled-trials.com).
切口疝会导致发病，可能需要进一步手术。HART（休斯腹部修复试验）评估了一种替代缝线方法对结直肠癌手术后切口疝发生率的影响。
一项实用的多中心单盲 RCT 将接受中线切口的结直肠癌患者随机分配至 Hughes 闭合组（双远-近-近-远缝线，在筋膜上每隔 2cm 用 1 根尼龙缝线，加常规肿块闭合）或外科医生的标准闭合组。主要结局是通过临床检查评估 1 年后切口疝的发生率。采用意向治疗分析。
2014 年 8 月至 2018 年 2 月，802 例患者被随机分配至 Hughes 闭合组（401 例）或标准肿块闭合组（401 例）。手术后 1 年，672 例患者（83.7%）纳入主要结局分析；Hughes 组 339 例患者中有 50 例（14.8%），标准闭合组 333 例患者中有 57 例（17.1%）发生切口疝（OR 0.84，95%置信区间 0.55 至 1.27；P=0.402）。术后 2 年，Hughes 修复组 78 例（28.7%）和标准闭合组 84 例（31.8%）发生切口疝（OR 0.86，0.59 至 1.25；P=0.429）。两组的不良事件相似，除了 Hughes 组的手术部位感染率较高（13.2%比 7.7%；OR 1.82，1.14 至 2.91；P=0.011）。
结直肠癌手术后切口疝的发生率较高。Hughes 闭合与肿块闭合在 1 年或 2 年时的发生率无统计学差异。
ISRCTN25616490（http://www.controlled-trials.com）。
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