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Review Article
Online Published: 22 Jan 2026
 


Prevalence and risk factors for incisional hernia after midline laparotomy, and strategies for prevention: a systematic review

Mohamed Suliman Ali Almahadi, Batool Meshal H. Alorayyidh, Norah Ibrahim A. Alabdullatif, Sultan Dhaifallah Alanazi, Bandar Nuwaysir Alruwaili, Sami Fayez M. Alanazi, Abdullah Ahmed A. Alsaleh, Majed Ahmed A. Alsaleh, Ahmed Meshal H. Alorayyidh.


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.


 
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How to Cite this Article
Pubmed Style

Almahadi MSA, Alorayyidh BMH, Alabdullatif NIA, Alanazi SD, Alruwaili BN, Alanazi SFM, Alsaleh AAA, Alsaleh MAA, Alorayyidh AMH. Prevalence and risk factors for incisional hernia after midline laparotomy, and strategies for prevention: a systematic review. IJMDC. 2026; 10(2): 807-815. doi:10.24911/IJMDC.51-1767635996

Web Style

Almahadi MSA, Alorayyidh BMH, Alabdullatif NIA, Alanazi SD, Alruwaili BN, Alanazi SFM, Alsaleh AAA, Alsaleh MAA, Alorayyidh AMH. Prevalence and risk factors for incisional hernia after midline laparotomy, and strategies for prevention: a systematic review. https://www.ijmdc.com/?mno=305722 [Access: June 27, 2026]. doi:10.24911/IJMDC.51-1767635996

AMA (American Medical Association) Style

Almahadi MSA, Alorayyidh BMH, Alabdullatif NIA, Alanazi SD, Alruwaili BN, Alanazi SFM, Alsaleh AAA, Alsaleh MAA, Alorayyidh AMH. Prevalence and risk factors for incisional hernia after midline laparotomy, and strategies for prevention: a systematic review. IJMDC. 2026; 10(2): 807-815. doi:10.24911/IJMDC.51-1767635996


Vancouver/ICMJE Style

Almahadi MSA, Alorayyidh BMH, Alabdullatif NIA, Alanazi SD, Alruwaili BN, Alanazi SFM, Alsaleh AAA, Alsaleh MAA, Alorayyidh AMH. Prevalence and risk factors for incisional hernia after midline laparotomy, and strategies for prevention: a systematic review. IJMDC. (2026), [cited June 27, 2026]; 10(2): 807-815. doi:10.24911/IJMDC.51-1767635996


Harvard Style

Almahadi, M. S. A., Alorayyidh, . B. M. H., Alabdullatif, . N. I. A., Alanazi, . S. D., Alruwaili, . B. N., Alanazi, . S. F. M., Alsaleh, . A. A. A., Alsaleh, . M. A. A. & Alorayyidh, . A. M. H. (2026) Prevalence and risk factors for incisional hernia after midline laparotomy, and strategies for prevention: a systematic review. IJMDC, 10 (2), 807-815. doi:10.24911/IJMDC.51-1767635996


Turabian Style

Almahadi, Mohamed Suliman Ali, Batool Meshal H. Alorayyidh, Norah Ibrahim A. Alabdullatif, Sultan Dhaifallah Alanazi, Bandar Nuwaysir Alruwaili, Sami Fayez M. Alanazi, Abdullah Ahmed A. Alsaleh, Majed Ahmed A. Alsaleh, and Ahmed Meshal H. Alorayyidh. 2026. Prevalence and risk factors for incisional hernia after midline laparotomy, and strategies for prevention: a systematic review. International Journal of Medicine in Developing Countries, 10 (2), 807-815. doi:10.24911/IJMDC.51-1767635996


Chicago Style

Almahadi, Mohamed Suliman Ali, Batool Meshal H. Alorayyidh, Norah Ibrahim A. Alabdullatif, Sultan Dhaifallah Alanazi, Bandar Nuwaysir Alruwaili, Sami Fayez M. Alanazi, Abdullah Ahmed A. Alsaleh, Majed Ahmed A. Alsaleh, and Ahmed Meshal H. Alorayyidh. "Prevalence and risk factors for incisional hernia after midline laparotomy, and strategies for prevention: a systematic review." International Journal of Medicine in Developing Countries 10 (2026), 807-815. doi:10.24911/IJMDC.51-1767635996


MLA (The Modern Language Association) Style

Almahadi, Mohamed Suliman Ali, Batool Meshal H. Alorayyidh, Norah Ibrahim A. Alabdullatif, Sultan Dhaifallah Alanazi, Bandar Nuwaysir Alruwaili, Sami Fayez M. Alanazi, Abdullah Ahmed A. Alsaleh, Majed Ahmed A. Alsaleh, and Ahmed Meshal H. Alorayyidh. "Prevalence and risk factors for incisional hernia after midline laparotomy, and strategies for prevention: a systematic review." International Journal of Medicine in Developing Countries 10.2 (2026), 807-815. Print. doi:10.24911/IJMDC.51-1767635996


APA (American Psychological Association) Style

Almahadi, M. S. A., Alorayyidh, . B. M. H., Alabdullatif, . N. I. A., Alanazi, . S. D., Alruwaili, . B. N., Alanazi, . S. F. M., Alsaleh, . A. A. A., Alsaleh, . M. A. A. & Alorayyidh, . A. M. H. (2026) Prevalence and risk factors for incisional hernia after midline laparotomy, and strategies for prevention: a systematic review. International Journal of Medicine in Developing Countries, 10 (2), 807-815. doi:10.24911/IJMDC.51-1767635996




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