The open approach is commonly used for most hepato-pancreato-biliary (HPB) procedures, with Incisional hernia (IH) being the commonest complication after open surgery. 

To date, very few published data on IH after HPB surgery exist; therefore, a recent study assessed the current evidence regarding incidence, risk factors, and prevention. It searched Medline/PubMed (1946–2020), EMBASE (1947–2020), and the Cochrane library (1995–2020) for studies on IH in open HPB surgery. It excluded Animal studies, editorials, letters, reviews, comments, short case series, and liver transplant, laparoscopic, or robotic procedures. 

The study retrieved a total of 5,079 articles and included Eight studies for the analysis. It found the incidence of IH after HPB surgery to range from 7.7% to 38.8%; and identified the risk factors as body mass index, surgical site infection, ascites, Mercedes or reversed T incisions, and previous IH. It found that the Prophylactic mesh might be safe and effective. 

To summarize, IH after open HPB surgery is yet a crucial issue. It is important to consider some risk factors, specific for the HPB operations and the incision type. Randomized controlled trials in the future must confirm the role of the prophylactic mesh after HPB operations.

Memba R, Morató O, Estalella L, et al. Prevention of Incisional Hernia after Open Hepato-Pancreato-Biliary Surgery: A Systematic Review. Dig Surg 2022;39:6–16. DOI: 10.1159/000521169