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

切口疝是开腹手术后最常见的并发症之一，在随机对照试验（RCT）中定期报告的发生率为10-30%。IH导致大量的发病率、成本、生活质量降低和死亡率。德国每年进行超过51，000例切口疝修补术，复发率高达30%。因此，预防IH是至关重要的。最近，提出了两项技术进步以减少切口疝形成：a.）用小缝技术闭合腹壁，以及B.）预防性补片植入。与传统的大咬合闭合技术相比，用于腹壁闭合的小缝线技术增加了用于闭合腹壁的缝线数量，从而将缝线长度与伤口长度之比增加到4以上。同样，初次手术时预防性补片植入可减少特定患者亚组的切口疝形成。最近的一项多中心RCT报告，两年后切口疝发生率低至13%。最重要的是，预防性补片组的其他临床显著伤口并发症没有增加。然而，以前从未将预防性补片放置与有前途的小缝线技术相结合。因此，HULC试验将研究这两种技术的组合是否会导致切口疝的额外减少。

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.