Prophylactic Mesh Reduced Incisional Hernia After HPB Surgery

Prophylactic synthetic mesh reinforcement during abdominal wall closure was associated with lower rates of radiologically detected incisional hernia at 12 and 24 months among high-risk patients undergoing open hepatobiliopancreatic surgery, according to a randomized clinical trial published in JAMA Surgery.

The prospective, double-blinded trial (meshproph) was conducted at Virgen Macarena Hospital in Seville, Spain, between July 2020 and December 2024. Investigators randomized 144 patients with at least 2 risk factors for incisional hernia who were scheduled for open right subcostal access. Five patients were excluded after meeting intraoperative exclusion criteria. Emergency surgery, metastatic disease, and unresectable malignant neoplasms identified during surgery were exclusion criteria.

The primary outcome was radiological incisional hernia at 12 to 24 months. At 12 months, hernia was detected in 5.2% of 57 patients analyzed in the mesh group, compared with 21% of 60 patients in the nonmesh group. At 24 months, it occurred in 4 of 49 patients (8.1%) in the mesh group and 18 of 48 (37.5%) in the nonmesh group. Both differences were statistically significant.

Investigators found no between-group differences in surgical site occurrences, postoperative complications, or postoperative pain. Patients in the mesh group also showed significant improvement in functional recovery, and the study found a significantly higher incisional hernia rate when a J incision was performed.

The 24-month analysis included 97 of 144 randomized patients, and the trial was conducted at a single hospital in selected high-risk patients undergoing a specific open surgical approach. Investigators concluded that prophylactic mesh reduced incisional hernia risk after hepatobiliary incisions without increasing postoperative complications.

Source: Bellido-Luque J, Sanchez-Matamoros Martín I, Reguera-Rosal J, Balla A, Morales-Conde S, Nogales Muñoz A. Prophylactic mesh placement and incisional hernia incidence in hepatobiliopancreatic surgery: a randomized clinical trial. JAMA Surg. Published online September 9, 2026. doi:10.1001/jamasurg.2026.4012