Efficacy and Safety of Prophylactic Mesh Reinforcement for the Prevention of Incisional Hernia: An Umbrella Review of Meta-Analyses.

Abstract

<h4>Introduction</h4>Incisional hernia (IH) is a frequent and expensive complication of laparotomy, occurring in up to 50% of high-risk patients. Although prophylactic mesh placement has been proposed as an effective preventive strategy of IH, its adoption remains limited due to concerns about mesh-related complications and the heterogeneity and variable quality of the available evidence. This umbrella meta-analysis aimed to synthesize the existing evidence to evaluate the efficacy and safety of prophylactic mesh reinforcement for IH prevention.<h4>Methods</h4>A systematic search of multiple databases was performed until June 2025 to identify meta-analyses comparing the use of prophylactic meshes versus primary closure in adults undergoing laparotomy. Methodological quality was assessed with the AMSTAR-2, and the data were reanalyzed with random or fixed effects models. Heterogeneity (I²), study overlap (CCA), publication bias, and robustness of the results were evaluated.<h4>Results</h4>Twenty-one meta-analyses were included. Prophylactic mesh reinforcement was associated with a significant reduction in the odds of incisional hernia (OR = 0.29; 95% CI: 0.22-0.38); this effect was consistent across different surgical settings. Mesh use was also associated with an increased risk of surgical site infection (OR = 1.17; 95% CI: 1.04-1.30) and seroma formation (OR = 2.31; 95% CI: 1.99-2.67). No significant differences were observed in abdominal wound dehiscence or hematoma. Overall, the evidence demonstrated a large and consistent effect, although substantial heterogeneity and signs of publication bias were present.<h4>Conclusion</h4>Prophylactic mesh reinforcement is associated with a reduced likelihood of incisional hernia but an increased risk of seroma and surgical site infection. Its use should be considered selectively in high-risk patients, balancing potential benefits against known complications. Further studies are needed to optimize patient selection and evaluate strategies to reduce mesh-related adverse outcomes, as well as to assess cost-effectiveness and quality-of-life outcomes.