The Prevention of Incisional Hernia

  • Y. Yurtkap
  • E. B. DeerenbergEmail author
  • J. J. Jeekel
  • J. F. Lange


Incisional hernia is a commonly occurring long-term complication following laparotomies. Risk factors for the development of incisional hernia may be divided into patient related risk factors and surgery related risk factors. Optimizing surgical techniques and used materials to close abdominal wall incisions hold the potential of preventing the development of incisional hernia, reducing postoperative disability and saving costs in the healthcare system. The surgical techniques and used suture materials for closing abdominal wall incisions are important determinative factors in preventing incisional hernia and will be discussed in this chapter. Furthermore, the placement of a prophylactic mesh in order to prevent an incisional hernia in high risk patients and optimization of patients pre-, peri- and postoperatively will be discussed.


Incisional hernias Prevention Suture techniques Suture materials Prophylactic mesh Patient optimization 


  1. 1.
    Bosanquet DC, Ansell J, Abdelrahman T, Cornish J, Harries R, Stimpson A, et al. Systematic review and meta-regression of factors affecting midline incisional hernia rates: analysis of 14,618 patients. PLoS One. 2015;10(9):e0138745.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Deerenberg EB, Harlaar JJ, Steyerberg EW, Lont HE, van Doorn HC, Heisterkamp J, et al. Small bites versus large bites for closure of abdominal midline incisions (STITCH): a double-blind, multicentre, randomised controlled trial. Lancet. 2015;386(10000):1254–60.CrossRefPubMedGoogle Scholar
  3. 3.
    Jairam AP, Timmermans L, Eker HH, Pierik R, van Klaveren D, Steyerberg EW, et al. Prevention of incisional hernia with prophylactic onlay and sublay mesh reinforcement versus primary suture only in midline laparotomies (PRIMA): 2-year follow-up of a multicentre, double-blind, randomised controlled trial. Lancet. 2017;390(10094):567–76.CrossRefPubMedGoogle Scholar
  4. 4.
    Alnassar S, Bawahab M, Abdoh A, Guzman R, Al Tuwaijiri T, Louridas G. Incisional hernia postrepair of abdominal aortic occlusive and aneurysmal disease: five-year incidence. Vascular. 2012;20(5):273–7.CrossRefPubMedGoogle Scholar
  5. 5.
    Itatsu K, Yokoyama Y, Sugawara G, Kubota H, Tojima Y, Kurumiya Y, et al. Incidence of and risk factors for incisional hernia after abdominal surgery. Br J Surg. 2014;101(11):1439–47.CrossRefPubMedGoogle Scholar
  6. 6.
    van Ramshorst GH, Eker HH, Hop WC, Jeekel J, Lange JF. Impact of incisional hernia on health-related quality of life and body image: a prospective cohort study. Am J Surg. 2012;204(2):144–50.CrossRefPubMedGoogle Scholar
  7. 7.
    Burger JW, Luijendijk RW, Hop WC, Halm JA, Verdaasdonk EG, Jeekel J. Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg. 2004;240(4):578–83. discussion 83–5PubMedPubMedCentralGoogle Scholar
  8. 8.
    Jenkins TP. The burst abdominal wound: a mechanical approach. Br J Surg. 1976;63(11):873–6.CrossRefPubMedGoogle Scholar
  9. 9.
    Israelsson LA, Jonsson T. Suture length to wound length ratio and healing of midline laparotomy incisions. Br J Surg. 1993;80(10):1284–6.CrossRefPubMedGoogle Scholar
  10. 10.
    Millbourn D, Israelsson LA. Wound complications and stitch length. Hernia. 2004;8(1):39–41.CrossRefPubMedGoogle Scholar
  11. 11.
    van’t Riet M, Steyerberg EW, Nellensteyn J, Bonjer HJ, Jeekel J. Meta-analysis of techniques for closure of midline abdominal incisions. Br J Surg. 2002;89(11):1350–6.CrossRefGoogle Scholar
  12. 12.
    Diener MK, Voss S, Jensen K, Buchler MW, Seiler CM. Elective midline laparotomy closure: the INLINE systematic review and meta-analysis. Ann Surg. 2010;251(5):843–56.CrossRefPubMedGoogle Scholar
  13. 13.
    Gurusamy KS, Cassar Delia E, Davidson BR. Peritoneal closure versus no peritoneal closure for patients undergoing non-obstetric abdominal operations. Cochrane Database Syst Rev. 2013;7:CD010424.Google Scholar
  14. 14.
    Muysoms FE, Antoniou SA, Bury K, Campanelli G, Conze J, Cuccurullo D, et al. European Hernia Society guidelines on the closure of abdominal wall incisions. Hernia. 2015;19(1):1–24.CrossRefPubMedGoogle Scholar
  15. 15.
    Lau FH, Wound PB. healing in acutely injured fascia. Wound Repair Regen. 2014;22(Suppl 1):14–7.CrossRefPubMedGoogle Scholar
  16. 16.
    Sajid MS, Parampalli U, Baig MK, McFall MR. A systematic review on the effectiveness of slowly-absorbable versus non-absorbable sutures for abdominal fascial closure following laparotomy. Int J Surg. 2011;9(8):615–25.CrossRefPubMedGoogle Scholar
  17. 17.
    Bloemen A, van Dooren P, Huizinga BF, Hoofwijk AG. Randomized clinical trial comparing polypropylene or polydioxanone for midline abdominal wall closure. Br J Surg. 2011;98(5):633–9.CrossRefPubMedGoogle Scholar
  18. 18.
    Henriksen NA, Deerenberg EB, Venclauskas L, Fortelny RH, Miserez M, Muysoms FE. The MATCH review: meta-analysis on Materials and Techniques for laparotomy closure. World J Surg. 2017.
  19. 19.
    Diener MK, Knebel P, Kieser M, Schuler P, Schiergens TS, Atanassov V, et al. Effectiveness of triclosan-coated PDS Plus versus uncoated PDS II sutures for prevention of surgical site infection after abdominal wall closure: the randomised controlled PROUD trial. Lancet. 2014;384(9938):142–52.CrossRefPubMedGoogle Scholar
  20. 20.
    Henriksen NADE, Venclauskas L, Fortelny RH, Garcia-Alamino JM, Miserez M, Muysoms FE. Triclosan-coated sutures and surgical site infection in abdominal surgery. The TRISTAN review, meta-analysis and trial sequential analysis. Hernia. 2017;21(6):833–41.CrossRefPubMedGoogle Scholar
  21. 21.
    Israelsson LA, Millbourn D. Prevention of incisional hernias: how to close a midline incision. Surg Clin North Am. 2013;93(5):1027–40.CrossRefPubMedGoogle Scholar
  22. 22.
    Murray BW, Cipher DJ, Pham T, Anthony T. The impact of surgical site infection on the development of incisional hernia and small bowel obstruction in colorectal surgery. Am J Surg. 2011;202(5):558–60.CrossRefPubMedGoogle Scholar
  23. 23.
    Payne R, Aldwinckle J, Ward S. Meta-analysis of randomised trials comparing the use of prophylactic mesh to standard midline closure in the reduction of incisional herniae. Hernia. 2017;21(6):843–53.CrossRefPubMedGoogle Scholar
  24. 24.
    Dronge AS, Perkal MF, Kancir S, Concato J, Aslan M, Rosenthal RA. Long-term glycemic control and postoperative infectious complications. Arch Surg. 2006;141(4):375–80. discussion 80CrossRefPubMedGoogle Scholar
  25. 25.
    Sorensen LT, Hemmingsen U, Kallehave F, Wille-Jorgensen P, Kjaergaard J, Moller LN, et al. Risk factors for tissue and wound complications in gastrointestinal surgery. Ann Surg. 2005;241(4):654–8.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Y. Yurtkap
    • 1
  • E. B. Deerenberg
    • 1
    Email author
  • J. J. Jeekel
    • 1
  • J. F. Lange
    • 2
  1. 1.Department of SurgeryErasmus MCRotterdamThe Netherlands
  2. 2.Department of NeuroscienceErasmus MCRotterdamThe Netherlands

Personalised recommendations