Clinical Report: Colorectal and Emergency Surgery in Relation to EHS/AHS Abdominal Closure Guidelines

Overview

Incisional hernia (IH) is a frequent complication after abdominal surgery, particularly in colorectal and emergency surgery patients who are at higher risk. This review critically appraises the evidence underpinning the 2022 EHS/AHS guidelines on abdominal wall closure, highlighting the representation and applicability of recommendations for these high-risk groups.

Background

Incisional hernia occurs in 5–20% of abdominal surgeries and significantly impacts patient quality of life and healthcare costs. Colorectal surgery patients, especially those undergoing cancer resections, have IH rates up to 31.8%, while emergency surgery patients may also have increased IH risk. Despite existing guidelines from EHS and AHS, there is heterogeneity in clinical practice and limited focus on specific surgical subgroups. This study evaluates the evidence base for guideline recommendations with a focus on colorectal and emergency surgery populations.

Data Highlights

Key Findings

• Incisional hernia rates are notably higher in colorectal surgery patients, reaching up to 31.8% at two years post-operation.
• Emergency surgery patients are also at increased risk for IH, though its role as an independent risk factor remains debated.
• The 2022 EHS/AHS guidelines are based on heterogeneous evidence with limited subgroup analyses specific to colorectal and emergency surgery patients.
• Among 39 references supporting the guidelines, 33 included colorectal and/or emergency surgery patients, but data granularity and risk-adapted recommendations are lacking.
• There is significant variation in abdominal wall closure techniques applied across different clinical scenarios, indicating a need for more tailored guidance.
• Quality assessments of included studies revealed variable methodological rigor, underscoring the need for higher-quality, focused research in these populations.

Clinical Implications

Clinicians should recognize the elevated risk of incisional hernia in colorectal and emergency surgery patients and consider this when planning abdominal wall closure. Current guidelines provide a general framework but may not fully address the specific needs of these high-risk groups. Tailored closure techniques and prophylactic strategies, such as mesh use, warrant further consideration and research to optimize outcomes.

Conclusion

This review highlights the underrepresentation and limited specificity of colorectal and emergency surgery patients in the evidence base for EHS/AHS abdominal closure guidelines. Enhanced, risk-adapted recommendations and focused research are needed to improve incisional hernia prevention in these vulnerable populations.

References

1. European Hernia Society and American Hernia Society Guidelines 2022 -- Abdominal Wall Closure
2. HART Trial -- Incisional Hernia Rates after Elective Colorectal Cancer Surgery
3. Systematic Review of Incisional Hernia Risk Factors -- 2015