"Happy to close?" The relationship between surgical experience and incisional hernia rates following abdominal wall closure in colorectal surgery

Laurie Smith^{1

2}, Alexandra Coxon-Meggy^{1

2}, Michael Shinkwin¹, Julie Cornish¹, Alan Watkins³, Greg Fegan³, Jared Torkington¹; HART Trial Collaborators

Collaborators, Affiliations

Collaborators

HART Trial Collaborators:
J Torkington, R Harries, S O'Connell, L Knight, S Islam, N Bashir, A Watkins, G Fegan, J Cornish, B Rees, H Cole, H Jarvis, S Jones, I Russell, D Bosanquet, A Cleves, B Sewell, A Farr, N Zbrzyzna, N Fiera, R Ellis-Owen, Z Hilton, C Parry, A Bradbury, P Wall, J Hill, D Winter, K Cocks, D Harris, J Hilton, S Vakis, D Hanratty, R Rajagopal, F Akbar, A Ben-Sassi, N Francis, L Jones, M Williamson, I Lindsey, R West, C Smart, P Ziprin, T Agarwal, G Faulkner, T Pinkney, D Vimalachandran, D Lawes, O Faiz, P Nisar, N Smart, T Wilson, A Myers, J Lund, S Smolarek, A Acheson, J Horwood, J Ansell, S Phillips, M Davies, L Davies, S Bird, N Palmer, M Williams, G Galanopoulos, P Dhruva Rao, D Jones, R Barnett, S Tate, J Wheat, N Patel, S Rahmani, E Toynton, L Smith, N Reeves, E Kealaher, G Williams, C Sekaran, M Evans, J Beynon, R Egan, E Qasem, U Khot, S Ather, P Mummigati, G Taylor, J Williamson, J Lim, A Powell, H Nageswaran, A Williams, J Padmanabhan, K Phillips, T Ford, J Edwards, N Varney, L Hicks, C Greenway, K Chesters, H Jones, P Blake, C Brown, L Roche, D Jones, M Feeney, P Shah, C Rutter, C McGrath, N Curtis, L Pippard, J Perry, J Allison, J Ockrim, R Dalton, A Allison, J Rendell, L Howard, K Beesley, G Dennison, J Burton, G Bowen, S Duberley, L Richards, J Giles, J Katebe, S Dalton, J Wood, E Courtney, R Hompes, A Poole, S Ward, L Wilkinson, L Hardstaff, M Bogden, M Al-Rashedy, C Fensom, N Lunt, M McCurrie, R Peacock, K Malik, H Burns, B Townley, P Hill, M Sadat, U Khan, C Wignall, D Murati, M Dhanaratne, S Quaid, S Gurram, D Smith, P Harris, J Pollard, G DiBenedetto, J Chadwick, R Hull, S Bach, D Morton, K Hollier, V Hardy, M Ghods, D Tyrrell, S Ashraf, J Glasbey, M Ashraf, S Garner, A Whitehouse, D Yeung, S Noor Mohamed, R Wilkin, N Suggett, C Lee, A Bagul, C McNeill, N Eardley, R Mahapatra, C Gabriel, P Datt, S Mahmud, I Daniels, F McDermott, M Nodolsk, L Park, H Scott, J Trickett, P Bearn, P Trivedi, V Frost, C Gray, M Croft, D Beral, J Osborne, R Pugh, G Herdman, R George, A-M Howell, S Al-Shahaby, B Narendrakumar, Y Mohsen, S Ijaz, M Nasseri, P Herrod, T Brear, J-J Reilly, A Sohal, C Otieno, W Lai, M Coleman, E Platt, A Patrick, C Pitman, S Balasubramanya, E Dickson, R Warman, C Newton, S Tani, J Simpson, A Banerjee, A Siddika, D Campion, D Humes, N Randhawa, J Saunders, B Bharathan, O Hay

Affiliations

¹ Department of Colorectal Surgery, University Hospital of Wales, Cardiff, UK.
² Cardiff University, Cardiff, UK.
³ Swansea Trials Unit, Swansea University Medical School, Swansea, UK.

PMID: 36965056
DOI: 10.1111/codi.16537

Randomized Controlled Trial

"Happy to close?" The relationship between surgical experience and incisional hernia rates following abdominal wall closure in colorectal surgery

Laurie Smith et al. Colorectal Dis. 2023 Jun.

. 2023 Jun;25(6):1222-1227.

doi: 10.1111/codi.16537. Epub 2023 Mar 25.

Authors

Laurie Smith^{1

2}, Alexandra Coxon-Meggy^{1

2}, Michael Shinkwin¹, Julie Cornish¹, Alan Watkins³, Greg Fegan³, Jared Torkington¹; HART Trial Collaborators

Collaborators

HART Trial Collaborators:
J Torkington, R Harries, S O'Connell, L Knight, S Islam, N Bashir, A Watkins, G Fegan, J Cornish, B Rees, H Cole, H Jarvis, S Jones, I Russell, D Bosanquet, A Cleves, B Sewell, A Farr, N Zbrzyzna, N Fiera, R Ellis-Owen, Z Hilton, C Parry, A Bradbury, P Wall, J Hill, D Winter, K Cocks, D Harris, J Hilton, S Vakis, D Hanratty, R Rajagopal, F Akbar, A Ben-Sassi, N Francis, L Jones, M Williamson, I Lindsey, R West, C Smart, P Ziprin, T Agarwal, G Faulkner, T Pinkney, D Vimalachandran, D Lawes, O Faiz, P Nisar, N Smart, T Wilson, A Myers, J Lund, S Smolarek, A Acheson, J Horwood, J Ansell, S Phillips, M Davies, L Davies, S Bird, N Palmer, M Williams, G Galanopoulos, P Dhruva Rao, D Jones, R Barnett, S Tate, J Wheat, N Patel, S Rahmani, E Toynton, L Smith, N Reeves, E Kealaher, G Williams, C Sekaran, M Evans, J Beynon, R Egan, E Qasem, U Khot, S Ather, P Mummigati, G Taylor, J Williamson, J Lim, A Powell, H Nageswaran, A Williams, J Padmanabhan, K Phillips, T Ford, J Edwards, N Varney, L Hicks, C Greenway, K Chesters, H Jones, P Blake, C Brown, L Roche, D Jones, M Feeney, P Shah, C Rutter, C McGrath, N Curtis, L Pippard, J Perry, J Allison, J Ockrim, R Dalton, A Allison, J Rendell, L Howard, K Beesley, G Dennison, J Burton, G Bowen, S Duberley, L Richards, J Giles, J Katebe, S Dalton, J Wood, E Courtney, R Hompes, A Poole, S Ward, L Wilkinson, L Hardstaff, M Bogden, M Al-Rashedy, C Fensom, N Lunt, M McCurrie, R Peacock, K Malik, H Burns, B Townley, P Hill, M Sadat, U Khan, C Wignall, D Murati, M Dhanaratne, S Quaid, S Gurram, D Smith, P Harris, J Pollard, G DiBenedetto, J Chadwick, R Hull, S Bach, D Morton, K Hollier, V Hardy, M Ghods, D Tyrrell, S Ashraf, J Glasbey, M Ashraf, S Garner, A Whitehouse, D Yeung, S Noor Mohamed, R Wilkin, N Suggett, C Lee, A Bagul, C McNeill, N Eardley, R Mahapatra, C Gabriel, P Datt, S Mahmud, I Daniels, F McDermott, M Nodolsk, L Park, H Scott, J Trickett, P Bearn, P Trivedi, V Frost, C Gray, M Croft, D Beral, J Osborne, R Pugh, G Herdman, R George, A-M Howell, S Al-Shahaby, B Narendrakumar, Y Mohsen, S Ijaz, M Nasseri, P Herrod, T Brear, J-J Reilly, A Sohal, C Otieno, W Lai, M Coleman, E Platt, A Patrick, C Pitman, S Balasubramanya, E Dickson, R Warman, C Newton, S Tani, J Simpson, A Banerjee, A Siddika, D Campion, D Humes, N Randhawa, J Saunders, B Bharathan, O Hay

Affiliations

¹ Department of Colorectal Surgery, University Hospital of Wales, Cardiff, UK.
² Cardiff University, Cardiff, UK.
³ Swansea Trials Unit, Swansea University Medical School, Swansea, UK.

PMID: 36965056
DOI: 10.1111/codi.16537

Abstract

Aim: Incisional hernia (IH) is a common complication of colorectal surgery, affecting up to 30% of patients at 2 years. Given the associated morbidity and high recurrence rates after attempted repair of IH, emphasis should be placed on prevention. There is an association between surgeon volume and outcomes in hernia surgery, yet there is little evidence regarding impact of the seniority of the surgeon performing abdominal wall closure on IH rate. The aim of our study was to assess the rates of IH at 1 year following abdominal wall closure between junior and senior surgeons in patients undergoing elective colorectal surgery.

Methods: This was an exploratory analysis of patients who underwent elective surgery for colorectal cancer between 2014-2018 as part of the Hughes Abdominal Repair Trial (HART), a prospective, multicentre randomised control trial comparing abdominal wall closure methods. Grade of surgeon performing abdominal closure was categorised into "trainee" and "consultant" and compared to IH rate at one year.

Results: A total of 663 patients were included in this retrospective analysis of patients in the HART trial. The rate of IH in patients closed by trainees was 20%, compared to 12% in those closed by consultants (p = <0.001). When comparing closure methods, IH rates were significantly higher in the Hughes closure arm between trainees and consultants (20% vs. 12%, p = 0.032), but not high enough in the mass closure arm to reach statistical significance (21% vs. 13%, p = 0.058). On multivariate analysis, age (p = 0.036, OR: 1.02, 95% CI: 1.00-1.04), Male sex (p = 0.049, OR: 1.61, 95% CI: 1.00-2.59) and closure by a trainee (p = 0.006, OR: 1.85, 95% CI: 1.20-2.85) were identified as risk factors for developing IH.

Conclusion: Patients who undergo abdominal wall closure by a surgeon in training have an increased risk of developing IH when compared to those closed by a consultant. Further work is needed to determine the impact of supervised and unsupervised trainees on IH rates, but abdominal wall closure should be regarded as a training opportunity in its own right.

Keywords: abdominal wall closure; incisional hernia; surgical training.

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References

REFERENCES

1. Torkington J, Harries R, O'Connell S, Knight L, Islam S, Bashir N, et al. Incisional hernia following colorectal cancer surgery according to suture technique: Hughes abdominal repair randomized trial (HART). Br J Surg. 2022;109(10):943-50.
1. Gignoux B, Bayon Y, Martin D, Phan R, Augusto V, Darnis B, et al. Incidence and risk factors for incisional hernia and recurrence: retrospective analysis of the French national database. Colorectal Dis. 2021;23(6):1515-23.
1. van Silfhout L, Leenders LAM, Heisterkamp J, Ibelings MS. Recurrent incisional hernia repair: surgical outcomes in correlation with body-mass index. Hernia. 2021;25(1):77-83.
1. Bosanquet DC, Ansell J, Abdelrahman T, Cornish J, Harries R, Stimpson A, et al. Systematic review and meta-regression of factors affecting midline incisional hernia rates: analysis of 14 618 patients. PLoS One. 2015;10(9):e0138745.
1. Jenkins TP. The burst abdominal wound: a mechanical approach. Br J Surg. 1976;63(11):873-6.

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"Happy to close?" The relationship between surgical experience and incisional hernia rates following abdominal wall closure in colorectal surgery

Collaborators

Affiliations

"Happy to close?" The relationship between surgical experience and incisional hernia rates following abdominal wall closure in colorectal surgery

Authors

Collaborators

Affiliations

Abstract

References

REFERENCES

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources