Title: Investigating risk factors for incisional hernia (IH): literature analysis and qualitative case studies to inform the design of a future cohort study
Funder: The Academy of Medical Sciences

Abstract: Feasibility work is required to inform a subsequent cohort study to establish risk factors for incisional hernias (IH) in patients undergoing open abdominal surgery. Objectives are to: 1) Identify â€˜reportedâ€™ risk factors for IH through literature analyses. 2) Identify â€˜unreportedâ€™ risk factors through operation observation, video analysis and semi-structured interviews with surgeons. . 3) Consensus methods will be used to define the data points to be measured and monitored in the future cohort study, informed by 1-2. 4) Establish a team to develop the future study Background: IH is a common and debilitating complication post abdominal surgery. Repair of IHs can be challenging and is associated with serious complications. To prevent IHs it is important to understand risk factors (technical and non-technical) for their development. Technical risk factors are more likely to be amenable to modification although the evidence behind all risk factors is limited. Therefore, surgeons continue to use different incisions to access the abdomen and various methods to close. A prospective cohort study would determine risk factors for IH but before it can be performed, feasibility work is required. Methods: 1) Use a snowballing review to identify key words reporting risk factors in the literature 2) Use direct observation, video-analysis of surgery and qualitative methods to explore â€˜unreportedâ€™ risk factors 3) Have a consensus meeting with key stake holders (including PPI groups) to determine risk factors to be monitored and measured in the future cohort study 4) A team will be developed in inform the future study design

Lay abstract: An incisional hernia (IH) is a complication of abdominal surgery. An IH develops when the muscle of the body wall splits, causing bulging of the skin next to the scar used for the initial surgery. An IH develops quite often, affecting up to 40% of patients within two years of their surgery. Having an IH may cause symptoms such as pain, limitation of activities of normal daily living, difficulty in wearing certain clothes and skin problems. An IH can sometimes cause unexpected hospital admissions to treat serious problems related to the hernia such as bowel obstruction. Treatment is often challenging and requires undertaking difficult surgery, which is often risky. Therefore, it is very important to prevent an IH during the index operation. Various types of incisions are used to access organs in the abdomen with no high-quality research evaluating whether the risk of a hernia is less with some incisions compared with others. The lack of research about these variations in technique mean there are several â€˜knownâ€™ and â€˜unknownâ€™ factors that influence IH development. This feasibility study will allow us to identify the â€˜knownâ€™ factors via a comprehensive review of the literature and the â€˜unknownâ€™ factors by interviewing and observing several surgeons undertaking abdominal operations. Finally, there will be a consensus meeting of experts to decide which factors are important and should be monitored in a larger observational study.

Research activity codes: 6.9 RESOURCES AND INFRASTRUCTURE (TREATMENT EVALUATION)
Health categories: ORAL AND GASTROINTESTINAL