Abstract
BACKGROUND: Incisional hernia remains the most common complication of open abdominal surgery. The aim was to investigate whether a reinforced tension-line suture combined with standard 4 : 1 small-bite closure reduces the 3-year incidence of computed tomography-detected incisional hernia in open colorectal cancer surgery. METHODS: Patients aged > 18 years, scheduled for colorectal cancer resection through a midline incision between 2017 and 2021 at Skåne University Hospital Malmö and Kristianstad County Hospital, Sweden, were eligible for inclusion. Patients were randomized to fascial closure by reinforced tension-line suture combined with 4 : 1 small-bite closure with polypropylene sutures (RTL group) or 4 : 1 small-bite closure alone with polydioxanone sutures (PDS group), in a 1 : 1 ratio. Computed tomography interpreters were blinded to study groups. Univariate, bivariate, and multivariate logistic regression analyses were performed to investigate and adjust study groups for potential risk factors for incisional hernia. RESULTS: The study randomized 80 patients in each group. At 3 years, 101 remained for analysis: 43 in the RTL group and 58 in the PDS group. Incisional hernia was detected in 27 patients: 6 of 43 (14%) in the RTL and 21 of 58 (36%) in the PDS group, resulting in a significant risk difference of 22% (odds ratio 3.50, 95% confidence interval 1.27 to 9.66; P = 0.016). In multivariate analysis, the PDS group (odds ratio 3.40, 1.14 to 10.14; P = 0.028) and adjuvant chemotherapy (odds ratio 2.98, 1.10 to 8.08; P = 0.032) were significant risk factors for incisional hernia. No adverse events related to the closure techniques were found in either group. CONCLUSION: Adding a reinforced tension-line suture significantly reduced the long-term incidence of incisional hernia compared with the 4 : 1 small-bite technique alone in patients undergoing open colorectal cancer surgery. These findings suggest that the reinforced tension-line suture is an efficient and easy way to prevent incisional hernia.