The Applicability of the European Hernia Society and American Hernia Society Guidelines on Abdominal Wound Closure in Colorectal and Emergency Surgery Patients: A Granular Analysis

Aim To critically appraise the evidence of the European and American Hernia Society guidelines on abdominal wall closure in colorectal and emergency patients. Material and Methods Relevant references addressing key questions (KQ) and recommendations were screened and included if colorectal/emergency surgery was reported. Data extraction was performed with a standardized form and authors were contacted for missing data. Quality and risk of bias were assessed independently by two reviewers. Results 33 studies were included: 15 systematic reviews and one literature review rated low or critically (AMSTAR 2); 12 randomized controlled trials with mostly moderate or high risk of bias (Cochrane RoB-2 tool); five observational studies of low to very low quality (GRADE) with serious risk of bias (ROBINS-I). 32 studies included colorectal (n = 15,856) and 14 emergency patients (n = 4,582). To answer KQ1 on ‘minimally invasive or open surgery’ and ‘type of incision’ 9/10 studies included colorectal and none emergency patients. 1/4 and 8/9 studies included colorectal/emergency patients for recommendations regarding trocar sites closure (KQ2) and closure after laparotomy (KQ3). For KQ5, regarding the use of mesh, 11/11 studies included colorectal/emergency patients. 3/3 and 1/1 studies included colorectal patients for KQ6 (abdominal binders) and KQ7 (restriction of activity), but none included emergency patients. Conclusions Recommendations on KQs 1, 3, 5, 6 and 7 are applicable to colorectal patients, but evidence for KQ 2 is lacking. The recommendations on KQs 1, 2 6 and 7 cannot be extrapolated to emergency patients. Furthermore, this study highlights the lack of other outcomes, important to patients.