Incisional hernias: epidemiology, evidence and guidelines

Abstract

From an epidemiological point of view, one third of the population in industrialized countries will undergo abdominal surgery during their lifetime. Depending on the degree of patient-related and procedure-related risks, the occurrence of incisional hernias is associated in arange of up to 30% at 2‑year follow-up and even up to 60% at 5years. In addition to influencing comorbidities, the type of surgical approach and closure technique are of critical importance. To present adescriptive evidence-based recommendation for abdominal wall closure and prophylactic mesh augmentation. Aconcise summary was prepared incorporating the current literature and existing guidelines. According to recent studies the recognized risk for the occurrence of incisional hernias in the presence of obesity and abdominal aortic diseases also applies to patients undergoing colorectal surgery and the presence of diastasis recti abdominis. Based on high-level published data, the short stitch technique for midline laparotomy in the elective setting has a high level of evidence to be astandard procedure. Patients with an increased risk profile should receive prophylactic mesh reinforcement, either onlay or sublay, in addition to the short stitch technique. In emergency laparotomy, the individual risk of infection with respect to the closure technique used must be included. The avoidance of incisional hernias is primarily achieved by the minimally invasive access for laparoscopy. For closure of the most commonly used midline approach, the short stitch technique and, in the case of existing risk factors, additionally mesh augmentation are recommended.