Evidence map›Paper›PMID 37814167›Full record

Trial reportSurgical endoscopy2023

The INCH-trial: a multicenter randomized controlled trial comparing short- and long-term outcomes of open and laparoscopic surgery for incisional hernia repair.

Nadine van Veenendaal, Marijn Poelman, Jan Apers, Huib Cense, Hermien Schreurs, Eric Sonneveld, Susanne van der Velde, Jaap Bonjer

Abstract readRandomized Controlled TrialMulticenter StudyEquivalence Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Surgical endoscopy, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed, 3 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

9 citing papers in PubMed, 3 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Does quality of life improve after complex incisional hernia repair? A systematic review.Hernia : the journal of hernias and abdominal wall surgery · 2025
    Pooled it
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  5. Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Nadine van VeenendaalDepartment of Surgery, Amsterdam University Medical Center, Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands. nadineveenendaal@hotmail.com.ORCID 0000-0002-4098-4644
Marijn PoelmanDepartment of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands.
Jan ApersDepartment of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands.
Huib CenseDepartment of Surgery, Red Cross Hospital, Beverwijk, The Netherlands.
Hermien SchreursDepartment of Surgery, Northwest Clinics, Alkmaar, The Netherlands.
Eric SonneveldDepartment of Surgery, Dijklander Hospital, Hoorn, The Netherlands.
Susanne van der VeldeDepartment of Surgery, Amsterdam University Medical Center, Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
Jaap BonjerDepartment of Surgery, Amsterdam University Medical Center, Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.

Funding

ZonMw 837002507
6 · The paper itself

Abstract

backgroundLaparoscopic incisional hernia repair is increasingly performed worldwide and expected to be superior to conventional open repair regarding hospital stay and quality of life (QoL). The INCisional Hernia-Trial was designed to test this hypothesis.

methodsA multicenter parallel randomized controlled open-label trial with a superiority design was conducted in six hospitals in the Netherlands. Patients with primary or recurrent incisional hernias were randomized by computer-guided block-randomization to undergo either conventional open or laparoscopic repair. Primary endpoint was postoperative length of hospital stay in days. Secondary endpoints included QoL, complications, and recurrences. Patients were followed up for at least 5 years.

resultsHundred-and-two patients were recruited and randomized. In total, 88 patients underwent surgery and were included in the intention-to-treat analysis (44 in the open group, 44 in the laparoscopic group). Mean age was 59.5 years, gender division was equal, and BMI was 28.8 kg/m. The trial was concluded early for futility after an unplanned interim analysis, which showed that the hypothesis needed to be rejected. There was no difference in primary outcome: length of hospital stay was 3 (range 1-36) days in the open group and 3 (range 1-12) days in the laparoscopic group (p = 0.481). There were no significant between-group differences in QoL questionnaires on the short and long term. Satisfaction was impaired in the open group. Overall recurrence rate was 19%, of which 16% in the open and 23% in the laparoscopic group (p = 0.25) at a mean follow-up of 6.6 years.

conclusionsIn a randomized controlled trial, short- and long-term outcomes after laparoscopic incisional hernia repair were not superior to open surgery. The persisting high recurrence rates, reduced QoL, and suboptimal satisfaction warrant the need for patient's expectation management in the preoperative process and individualized surgical management.

trial registrationNetherlands Trial Register NTR2808.

Indexed as

Hernia, VentralIncisional HerniaLaparoscopyHerniorrhaphyHumansLength of StayMiddle AgedPostoperative ComplicationsQuality of LifeRecurrenceSurgical MeshAbdominal wallIncisional herniaLaparoscopic repairOpen repairQuality of lifeRCT

Identifiers

PMID37814167
PMCPMC10709221

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.