Prevention of Postoperative Hernias in Emergency Surgery - PROPHECY Trial

Abstract

Background: Postoperative hernias are a common and significant late complication following emergency abdominal surgery. Despite numerous preventive strategies, their incidence remains high, leading to morbidity, reoperations, and reduced quality of life. The PROPHECY trial is designed to assess the incidence of postoperative hernias and identify modifiable perioperative risk factors in patients undergoing urgent and emergency abdominal operations.

Methods: This national, prospective, multicentre, observational cohort study will include adult patients undergoing emergency abdominal surgery for specific indications such as acute appendicitis, cholecystitis, incarcerated hernias, gastrointestinal perforation, or bowel obstruction. The study period extends from 1 June 2025 to 31 December 2026, with recruitment completed by the end of 2025 and follow-up completed by the end of 2026. Data on demographics, comorbidities, surgical techniques, postoperative management, and complication rates will be collected. The primary endpoints are incisional hernia, port-site hernia, and parastomal hernia. Secondary endpoints include surgical site infections (SSI) and burst abdomen. Follow-up will be conducted via structured telephone interviews and clinical or imaging confirmation. Based on power calculations for primary and secondary outcomes, the study will include 500 patients, providing adequate statistical strength while maintaining feasibility across participating centres.

Trial registration: ClinicalTrials.gov ID: NCT06815822.

Keywords: burst abdomen; emergency surgery; parastomal hernia; port-site hernia; postoperative hernia.