Prevention of Incisional Hernia: What is new?

Incisional hernia (IH) is among the commonest post-operative complication after midline laparotomy. In spite of all technological advances its incidence remains 5-26%; prompting surgeons to think about IH prevention techniques. A scrutiny of factors associated with IH clearly shows that most of these are patient related and are beyond the Surgeon’s control. However, there are a few Surgeon-related preventive measures which can help in bringing down the incidence of IH. These include efforts directed at reducing surgical site infection, preferred use of laparoscopy over conventional open surgery, preferred use of transverse incision, using current recommendations for midline laparotomy closure, incisional reinforcement in high risk groups by prophylactic mesh, special incisions/ techniques for prevention of IH in special circumstances, identification of high-risk cases and their centralized care, and increasing awareness of safety of synthetic mesh in presence of infection and strangulation. This brief review is based on relevant published literature in ‘PubMed’ and ‘Google Scholar’ since 2013. Now that it is possible to identify high risk patients for development of IH, high quality evidence is available for its prevention and the preventive measures do not require expansive resources; time has come to convert available knowledge to implementation.