ArticleHernia : the journal of hernias and abdominal wall surgery2025
Colorectal and emergency surgical patients in the literature supporting EHS and AHS guidelines on abdominal wound closure: a granular analysis.
Article in Hernia : the journal of hernias and abdominal wall surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
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Authors and funding
10 authors.
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Abstract
backgroundTo critically appraise the evidence supporting the European and American Hernia Society (EHS/AHS) guidelines on abdominal wall closure in colorectal and emergency surgery patients, we conducted a granular analysis focused on the representation and quality of available data.
methodsReferences that addressed key questions (KQ) and recommendations in the original guidelines were screened and included if colorectal/emergency surgery was reported. Data extraction was performed with a standardised form and authors were contacted for missing data. Quality and risk of bias were assessed independently by two reviewers.
resultsOut of 33 studies included: 15 systematic reviews and one literature review were rated low or critically low (AMSTAR 2); 12 randomised controlled trials had moderate to high risk of bias (Cochrane RoB-2 tool); five observational studies were 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 no studies included emergency patients. 1/4 and 8/9 studies included colorectal/emergency patients for recommendations regarding trocar sites closure (KQ2) and closure after laparotomy (KQ3). Regarding the use of mesh (KQ5), 11/11 studies included colorectal/emergency patients. 3/3 and 1 studies included colorectal patients for KQ6 (abdominal binders) and one for KQ7 (restriction of activity), but none included emergency patients.
conclusionRecommendations for KQs 1, 3, 5, 6, and 7 appear applicable to colorectal patients, whereas evidence for KQ2 remains insufficient. For emergency patients, recommendations related to KQs 1, 2, 6, and 7 should not be extrapolated. This study further highlights critical limitations in the evidence base, including the lack of patient-centred outcomes, and underscores the need for targeted, high-quality research in these populations.
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