Prevention of incisional hernias of the abdominal wall: Risk factors, considerations, and optimal closure technique

Abstract

Introduction: The increase in abdominal surgeries, whether by laparotomy or laparoscopy, has significantly increased the incidence and prevalence of incisional hernias, which are a common surgical complication and result in significant healthcare costs. However, over time, it has been discovered that these can be prevented or reduced by determining risk factors in patients prior to surgery and using certain techniques. Objective: To learn how to prevent incisional hernias by determining patient risk factors and using an appropriate surgical technique for closing the abdominal wall. Methodology: A search was conducted for articles published in PubMed, Epistmonikos, and Google Scholar in the last 10 years. Results and Discussion: There are multiple risk factors that predispose patients to the development of incisional hernias, most of which are modifiable, and the risk can be reduced by controlling them prior to surgery. Furthermore, techniques for primary closure of the abdominal wall have been described that significantly reduce the occurrence of incisional hernias. Conclusion: Risk factors for incisional hernias are increasingly common in the general population, and there are surgical techniques and considerations that should be taken into account when closing the abdominal wall, notably the use of slow-absorbing monofilament sutures, closure of the aponeurosis alone with continuous ‘small-bite’ stitches, and the application of reinforcement stitches or abdominal mesh to reduce the risk, mainly in patients at high risk of developing incisional hernias.