Abstract
Abstract Aim Incisional Hernia (IH) is a common complication of colorectal surgery, affecting up to 30% of patients. There is an association between surgeon experience and outcomes in hernia surgery, yet little regarding impact of the surgeon performing abdominal wall closure (AWC) on IH rate. We aimed to assess the rates of IH at 1 year following AWC between junior and senior surgeons in patients undergoing colorectal surgery. Method This is an exploratory analysis of patients who participated in the Hughes Abdominal Repair Trial (HART), a prospective, multicentre randomised control trial comparing AWC methods. Grade of surgeon performing AWC was categorised into ‘Trainee’ and ‘Consultant’ and compared to IH rate at 1 year. Results 663 patients were included. The rate of IH in patients closed by trainees was 20%, compared to 12% in those closed by consultants (P = <0.001). Patients closed by trainees were more likely to have had rectal surgery. Patients closed by consultants were more likely to be younger and have a longer duration of surgery. On multivariate analysis, age, male sex and closure by a trainee were identified as risk factors for developing IH. Conclusion Patients who undergo AWC by a trainee have an increased risk of developing IH when compared to those closed by a consultant. Further work is needed to determine the impact of supervised and un-supervised trainees on IH rates. AWC should be regarded as a training opportunity in its own right, and closure time should be seen as training time, not coffee time.
Published Version
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