Incisional hernia can occur in up to 40% of patients after hepatobiliopancreatic surgery. A prospective randomized clinical trial evaluated whether prophylactic synthetic mesh placement during abdominal wall closure could reduce this complication in high-risk patients undergoing open right subcostal access. The study randomized 144 patients to conventional closure or synthetic mesh-reinforced closure, with 5 patients subsequently excluded based on intraoperative criteria.

At 12-month follow-up, radiological incisional hernia occurred in 5.2% of patients in the mesh group compared with 21% in the nonmesh group, representing a significant reduction. At 24 months, the rate remained significantly lower with mesh, occurring in 8.1% of patients compared with 37.5% in the nonmesh group. No significant differences were identified between groups in surgical site occurrences, postoperative…