Reduced Incisional Hernia Incidence After Colorectal Cancer Surgery- The Rein4ceto1 Randomized Controlled Trial

Aim Incisional hernia (IH) is a common long-term complication after surgery for colorectal cancer (CRC). Using a prophylactic mesh reduces the incidence, but many surgeons hesitate mostly due to the fear of surgical site infections. The aim of this study was to investigate if the reinforced tension line (RTL) suture technique reduces the IH incidence after elective CRC surgery. Materials and Methods In this randomized controlled clinical trial, patients planned for CRC surgery through a midline incision at two Swedish hospitals, October 2017 until May 2021, were eligible for inclusion. Patients >18 years were randomized to two different fascia closure techniques: 4:1 small-bite technique with polydioxanone suture (the PDS-group) or RTL+ the 4:1 small-bite technique with polypropylene sutures (the RTL-group). The CT-diagnosed IH incidence was compared 1 year postoperatively. Results Total 248 patients were eligible, of which 160 (86M, 74F, mean BMI 25.6) were randomized at operation and 134 patients remained for analysis at 1 year; 71 in the PDS group and 63 in the RTL-group. IH was found in 19 patients: 15 (21.1%) in the PDS-group and 4 (6.4%) in the RTL-group (p ≤ 0.014, OR 3.95, 95% CI 1.24–12.6). No difference was found in base-line characteristics, surgical site occurrences or overall complications according to the Clavien-Dindo classification. Neoadjuvant radiotherapy was more frequent (p = 0.030), more patients received stomas (p = 0.020) and fascia closure time was longer in the RTL-group (p < 0.001). Conclusions We found fewer CT-diagnosed IH one year after fascia closure with the RTL technique in electively operated CRC patients.