Hernia reduction following laparotmy using small stitch abdominal wall closure with or without mesh augmentration (HULC)

• Applicant: Professor Dr. Andre Mihaljevic
• Subject Area: General and Visceral Surgery
• Term: since 2019
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 410901776

Incisional hernias are one of the most frequent complications following open abdominal surgery with rates of 10-30% being regularly reported in randomized controlled trials (RCTs). IHs cause substantial morbidity, costs, reduction in quality of life and mortality. More than 51,000 incisional hernia repairs are performed in Germany each year with unacceptable high recurrence rates of up to 30%. Therefore, prevention of IHs is of utmost importance. Recently, two technical advances were proposed to reduce incisional hernia formation: a.) closure of the abdominal wall in small stitch technique and b.) prophylactic mesh implantation. Small stitches technique for abdominal wall closure increases the number of stitches used to close the abdominal wall in comparison to traditional large bite closure techniques, thereby increasing the suture-length to wound-length ratio to over four. Similarly, prophylactic mesh implantation at the time of primary surgery was shown to reduce incisional hernia formation in specific subsets of patients. A recent multicentre RCT reported incisional hernia rates as low as 13% after two years. Most importantly, other clinically significant wound complications were not increased in the prophylactic mesh group. However, never before prophylactic mesh placement has been combined with the promising small stitches technique. Thus, the HULC trial will investigate whether a combination of these two techniques leads to an additional reduction of incisional hernias.

• DFG Programme: Clinical Trials