Defining High-Risk Patients Suitable for Incisional Hernia Prevention

Abstract

There is a 9%–20% incisional hernia (IH) rate 1 year after midline laparotomy (1, 2) increasing up to 22.4% after 3 years of follow-up (3). Several prospective studies (4–7), metanalyses (8, 9) and guidelines (10) advise or have demonstrated that the use of prophylactic mesh (PM) reduces IH. Despite all these studies, the use of PM has not been spread worldwide (11). Among other reasons, this is because it is unknown for which patients the potential benefits outweigh the risks of complications when using a PM. Likewise, there are several concerns among surgeons regarding which complications can occur using a PM (remarkably chronic pain and infection) (12). Due to these, it is necessary to determine diseases, patients and situations where high risks of IH justify consideration of using a PM. This paper aims to review as an opinion article the scientific data on situations, patients and diseases with a higher risk of IH in which PM should be considered.