Abstract

Incisional hernia (IH) is a frequent and problematic long-term complication following midline laparotomy that significantly impacts patient morbidity and healthcare costs. This systematic review aimed to synthesize recent evidence regarding the prevalence, risk factors, and preventive measures for IH after midline laparotomy. A systematic search was conducted in PubMed/MEDLINE, Scopus, and Cochrane Central, including studies published between January 2020 and December 2025. Eligible studies comprised randomized controlled trials, cohort studies, and comparative studies assessing the incidence of IH, risk factors, or prevention methods in adults undergoing midline laparotomy. Due to methodological heterogeneity, a narrative synthesis was performed. Eight articles were included. IH occurrence varied among patients, with certain subgroups at higher risk. Radiographic IH rates were particularly high in obese patients (51.9%), and the odds of IH increased six-fold in patients with surgical site infection (SSI). Prophylactic mesh reinforcement, especially in the retrorectus or sublay position, demonstrated favorable and effective outcomes, achieving 0% IH rates in some high-risk groups at 5 years. Other preventive measures, such as the Reinforced Tension Line suture and subcutaneous closed suction drainage in emergency settings, also showed significant protective effects. Bioabsorbable mesh provided only a temporary benefit. Obesity and SSI were identified as major patient-specific risk factors for IH. In high-risk elective patients, long-term placement of a non-absorbable mesh appears to be the most effective prophylactic strategy. To minimize IH occurrence, closure techniques should be tailored to individual risk profiles and clinical context. Future research should prioritize emergency settings and standardized outcome reporting.

Key words: Incisional hernia, midline laparotomy, risk factors, prevention, prophylactic mesh, systematic review.