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Incisional hernia can affect more than 30% of high-risk patients undergoing a laparotomy, leading to a great impact on both quality of life and healthcare costs. Impaired wound healing underlies the development of a hernia during the first months after surgery. Anatomic dysfunction perpetuates the atrophy and fibrosis of abdominal wall muscles, causing both gastrointestinal and respiratory problems.
The benefits of prophylactic mesh augmentation have been proved in selected populations, even though strong evidence is currently lacking in clinical practice guidelines. Some patients have been found to have a higher risk for this pathology. A preoperative assessment of the risk for HI should be performed to select patients who could benefit from this preventive measure.
Incisional hernia prevention requires careful surgical technique, both in performing the abdominal incision and in its closure. An onlay prophylactic mesh can be used in patients with high-risk factors for incisional hernia.
Abdominal wall departments are related to better outcomes in abdominal wall surgery. More attention needs to be pàod to the training of young surgeons and residents in abdominal wall closure techniques. We review the latest evidence on this subject as new mesh augmentation protocols for midline laparotomies are starting to be used by some specialized teams.