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Updated: Dec 28, 2025
Application of a New Mesh Fixation Method in Laparoscopic Incisional Hernia Repair
Published on: December 23, 2022
Prevention of incisional hernia after midline laparotomy with prophylactic mesh reinforcement: a meta-analysis and
A P Jairam1, M López-Cano2, J M Garcia-Alamino3
1Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, Netherlands.
Background:
Incisional hernia is a frequent complication after abdominal surgery. The aim of this study was to assess the efficacy of prophylactic mesh reinforcement (PMR) after midline laparotomy in reducing the incidence of incisional hernia.
Methods:
A meta-analysis was conducted following PRISMA guidelines. The primary outcome was the incidence of incisional hernia after follow-up of at least 12 months. Secondary outcomes were postoperative complications. Only RCTs were included. A random-effects model was used for the meta-analysis, and trial sequential analysis was conducted.
Results:
Twelve RCTs were included, comprising 1815 patients. The incidence of incisional hernia was significantly lower after PMR compared with sutured closure (risk ratio (RR) 0·35, 95 per cent c.i. 0·21 to 0·57; P < 0·001). Both onlay (RR 0·26, 0·11 to 0·67; P = 0·005) and retromuscular (RR 0·28, 0·10 to 0·82; P = 0·02) PMR led to a significant reduction in the rate of incisional hernia. The occurrence of seroma was higher in patients who had onlay PMR (RR 2·23, 1·10 to 4·52; P = 0·03). PMR did not result in an increased rate of surgical-site infection.
Conclusion:
PMR of a midline laparotomy using an onlay or retromuscular technique leads to a significant reduction in the rate of incisional hernia in high-risk patients. Individual risk factors should be taken into account to select patients who will benefit most. [Correction added on 19 February 2020, after first online publication: J. García Alamino has been amended to J. M. Garcia-Alamino].
Insights
Prophylactic mesh reinforcement (PMR) significantly reduces incisional hernia after midline laparotomy. This surgical technique is effective for high-risk patients, lowering hernia incidence without increasing infection rates.
Area of Science:
- Surgical innovation and outcomes research
- Abdominal surgery and hernia repair
- Evidence-based medicine and meta-analysis
Background:
- Incisional hernia is a common complication following abdominal surgery.
- Midline laparotomy presents a significant risk for developing incisional hernias.
- Prophylactic mesh reinforcement (PMR) is explored as a preventive strategy.
Purpose of the Study:
- To evaluate the efficacy of prophylactic mesh reinforcement (PMR) in preventing incisional hernias after midline laparotomy.
- To compare the incidence of incisional hernias between PMR and traditional sutured closure.
- To assess associated postoperative complications with PMR.
Main Methods:
- A meta-analysis of randomized controlled trials (RCTs) was performed, adhering to PRISMA guidelines.
- The primary outcome measured was the incidence of incisional hernia at a minimum 12-month follow-up.
- A random-effects model and trial sequential analysis were employed to synthesize data from 12 RCTs involving 1815 patients.
Main Results:
- PMR significantly reduced the incidence of incisional hernia compared to sutured closure (RR 0.35).
- Both onlay and retromuscular PMR techniques demonstrated significant hernia reduction (RR 0.26 and 0.28, respectively).
- While onlay PMR increased seroma occurrence (RR 2.23), overall surgical-site infection rates were not elevated.
Conclusions:
- Prophylactic mesh reinforcement (PMR) using onlay or retromuscular techniques effectively reduces incisional hernias after midline laparotomy, particularly in high-risk individuals.
- Patient-specific risk factors are crucial for identifying those most likely to benefit from PMR.
- PMR offers a viable option for reducing incisional hernia rates without a significant increase in surgical site infections.
