Efficacy of far-near-near-far (Hughes) technique in closure of midline exploratory wound for reducing the incidence of incisional hernia in comparison with conventional mass closure

Abstract

Background Incisional hernia is the commonest complexity for closure of midline incision after the abdominal surgery, causing morbidity, impaired life quality, and higher costs of health care. Hughes technique merges a standard mass closure with a chain of horizontal and two vertical mattress sutures within a single suture. Theoretically, this will spread the loading over the length of the incision in addition to across it. So, this technique is more effective for preventing the formation of incisional hernia after a closure of the midline incision. Aim The purpose of this investigation was to clarify the performance of Hughes technique in closure of midline exploratory wounds for reducing the incidence of postoperative dehiscence, either burst abdomen or incisional hernia, in comparison with conventional mass closure. Patients and methods Between June 2017 and November 2019, this prospective study was carried out on 100 patients. Patients were categorized randomly into two groups: group A included 50 patients who were closed by simple conventional mass closure, and group B included 50 patients who were closed by simple conventional mass closure along with far-near-near-far (Hughes) technique using vicryl 1 sutures. Results There was no significant difference between groups regarding basic demographic and clinical data. The operation duration and hospital stay were longer in Hughes, but with no significant difference. Furthermore, there was no significant difference regarding infection, but dehiscence was significantly associated more with mass technique. Moreover, Hughes group had significantly higher scores regarding visual analog scal (VAS) at 2 and 4 h, and thereafter the two groups were nearly matched till 24 h. Hughes technique was preferable in reduction of postoperative dehiscence, either burst abdomen or incisional hernia. Furthermore, better surgeon and patient satisfaction was gained. Conclusion The authors can conclude that the Hughes technique is more effective and preferable as a mesh repair for the handling and preventing the formation of incisional hernia after the closure of a midline wound in comparison with conventional mass closure.