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Updated: Jan 19, 2026
Application of a New Mesh Fixation Method in Laparoscopic Incisional Hernia Repair
Published on: December 23, 2022
The role of prophylactic mesh placement to prevent incisional hernia in laparotomy. Is it time to change practice?
Michael Sugrue1,2, Alison Johnston1, Saqib Zeeshan1
1Department of Surgery, Letterkenny University Hospital and Donegal Clinical Research Academy, Ireland.
Background:
Incisional hernia (IH) occurs in approximately 25% of laparotomies. Prophylactic mesh placement (PMP) may significantly reduce IH but is not widely used. This paper will review the evidence relating to the role of PMP in laparotomy and its ability to effectively and safely have an impact on hernia reduction.
Methods:
An ethically approved review of all published English articles relating to IH prevention following laparotomy was undertaken at Letterkenny University Hospital by searching PubMed, Scopus, and electronic databases over a 20-year period from January 1999 to March 2019. The search terms "incisional hernia", "laparotomy", "mesh placement", "reoperation", "readmitted", and "rates" were used in combination.
Results:
The literature identified 17 publications, of which 14 were randomised, controlled trials and three were prospective cohort studies from 22 countries. Bariatric surgery accounted for eight of the 17 studies. Onlay mesh placement was used in five studies. Preperitoneal, retrorectus, intra-peritoneal, combinations of and sublay were used in 4, 3, 2, 2, and 1 studies, respectively. In two studies both sublay and onlay were performed. A total of 2777 patients were reported. One study had two publications with different lengths of follow-up.
Conclusions:
Currently surgeons need to consider changing practice to firstly ensure they practice optimum laparotomy closure technique and potentially use PMP. If not using PMP they need to question why, because PMP will more than halve the IH rate, especially in higher risk patients undergoing laparotomy.
Insights
Prophylactic mesh placement (PMP) can significantly reduce incisional hernias (IH) after laparotomy, more than halving the IH rate, especially in high-risk patients. Surgeons should consider PMP to improve patient outcomes and reduce hernia occurrence.
Area of Science:
- Surgical innovation
- Hernia repair
- Evidence-based medicine
Background:
- Incisional hernia (IH) affects approximately 25% of patients undergoing laparotomy.
- Prophylactic mesh placement (PMP) is underutilized despite its potential to reduce IH rates.
Purpose of the Study:
- To review the existing evidence on the role of PMP in preventing IH after laparotomy.
- To assess the effectiveness and safety of PMP in reducing hernia occurrence.
Main Methods:
- Systematic review of English-language articles published between January 1999 and March 2019.
- Searched PubMed, Scopus, and other electronic databases using terms like "incisional hernia," "laparotomy," and "mesh placement."
- Included randomized controlled trials and prospective cohort studies.
Main Results:
- 17 publications were identified, including 14 randomized controlled trials and 3 prospective cohort studies, reporting on 2777 patients.
- Various mesh placement techniques were analyzed, including onlay, preperitoneal, retrorectus, and sublay.
- Bariatric surgery patients were a significant focus, accounting for 8 of the 17 studies.
Conclusions:
- PMP can more than halve the incidence of incisional hernias following laparotomy, particularly in high-risk individuals.
- Surgeons should optimize laparotomy closure techniques and strongly consider implementing PMP.
- The evidence supports a shift in surgical practice towards routine PMP for IH prevention.
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