{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T15:23:19Z","timestamp":1788967399455,"version":"build-2803163510"},"reference-count":21,"publisher":"American Medical Association (AMA)","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Surg"],"abstract":"\n Importance<\/jats:title>\n The incidence of incisional hernia after hepatobiliopancreatic surgery could reach 40%. There is a lack of evidence regarding the use of prophylactic mesh in subcostal incisions.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate whether prophylactic mesh placement during abdominal wall closure reduces the rate of incisional hernias.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This prospective, double-blinded randomized clinical trial was conducted between July 2020 and December 2024 at Virgen Macarena Hospital in Seville, Spain. Patients with 2 or more risk factors for incisional hernias and scheduled for open right subcostal access were considered. Exclusion criteria included emergency surgery, metastatic disease, or unresectable malignant neoplasm identified during the surgery. Follow-up was at 1, 3, 6, 12, and 24 months, postoperatively.<\/jats:p>\n <\/jats:sec>\n \n Intervention<\/jats:title>\n Conventional abdominal wall closure vs conventional closure with prophylactic synthetic mesh placement.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcome measure was radiological incisional hernia after 12 to 24 months. Secondary outcomes included incision type (Kocher or J incision), postoperative complications, surgical site occurrences rate, postoperative pain, and functional recovery.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n There were 144 patients randomized to either conventional closure (n\u2009=\u200969) or synthetic mesh-reinforced closure (n\u2009=\u200975); after 5 patients were excluded because of intraoperative exclusion criteria, 66 patients were assigned to the mesh group and 73 patients to the nonmesh group. At 12-month follow-up, 57 patients in the mesh group and 60 in the nonmesh group were analyzed; 5.2% of patients in the mesh group and 21% in the nonmesh group showed a radiological incisional hernia, with a significant reduction of incisional hernia rate. After 24 months of follow-up, 49 patients in the mesh group and 48 patients in the nonmesh group were analyzed; radiological incisional hernia rate was significantly increased in no-mesh group with 18 (37.5%) patients and 4 (8.1%) patients in mesh group. No differences in surgical site occurrences, postoperative complications, or postoperative pain were identified between the groups. Patients in the mesh group showed significant improvement in functional recovery. This study showed a significantly higher incisional hernia rate when a J incision was performed.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n This randomized clinical trial found that prophylactic mesh placement significantly reduced the overall risk of incisional hernia after hepatobiliary incisions without increasing postoperative complications. These results suggest that to prevent incisional hernias after hepatobiliary surgery through a subcostal incision, the placement of a synthetic mesh during abdominal wall closure should be considered.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT07433439<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamasurg.2026.4012","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T15:00:28Z","timestamp":1788966028000},"source":"Crossref","is-referenced-by-count":0,"title":["Prophylactic Mesh Placement and Incisional Hernia Incidence in Hepatobiliopancreatic Surgery"],"prefix":"10.1001","author":[{"given":"Juan","family":"Bellido-Luque","sequence":"first","affiliation":[{"name":"Hepatobiliary Surgical Unit, Gastrointestinal Surgical Department, Virgen Macarena Hospital, University of Seville, Seville, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inmaculada","family":"Sanchez-Matamoros Mart\u00edn","sequence":"additional","affiliation":[{"name":"Hepatobiliary Surgical Unit, Gastrointestinal Surgical Department, Virgen Macarena Hospital, University of Seville, Seville, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julio","family":"Reguera-Rosal","sequence":"additional","affiliation":[{"name":"Hepatobiliary Surgical Unit, Gastrointestinal Surgical Department, Virgen Macarena Hospital, Seville, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Balla","sequence":"additional","affiliation":[{"name":"Gastrointestinal Surgical Department, Virgen Macarena Hospital, Seville, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvador","family":"Morales-Conde","sequence":"additional","affiliation":[{"name":"Gastrointestinal Surgical Department, Virgen Macarena Hospital, University of Seville, Seville, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angel","family":"Nogales Mu\u00f1oz","sequence":"additional","affiliation":[{"name":"Hepatobiliary Surgical Unit, Gastrointestinal Surgical Department, Virgen Macarena Hospital, University of Seville, Seville, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2026,9,9]]},"reference":[{"issue":"10000","key":"soi260060r1","doi-asserted-by":"publisher","first-page":"1254","DOI":"10.1016\/S0140-6736(15)60459-7","article-title":"Small bites versus large bites for closure of abdominal midline incisions (STITCH): a double-blind, multicentre, randomised controlled trial.","volume":"386","author":"Deerenberg","year":"2015","journal-title":"Lancet"},{"issue":"6","key":"soi260060r2","doi-asserted-by":"publisher","first-page":"843","DOI":"10.1007\/s10029-017-1653-4","article-title":"Meta-analysis of randomised trials comparing the use of prophylactic mesh to standard midline closure in the reduction of incisional herniae.","volume":"21","author":"Payne","year":"2017","journal-title":"Hernia"},{"issue":"3","key":"soi260060r3","doi-asserted-by":"publisher","first-page":"357","DOI":"10.1002\/bjs5.50261","article-title":"Prevention of incisional hernia after midline laparotomy with prophylactic mesh reinforcement: a meta-analysis and trial sequential analysis.","volume":"4","author":"Jairam","year":"2020","journal-title":"BJS Open"},{"issue":"5","key":"soi260060r4","doi-asserted-by":"publisher","first-page":"436","DOI":"10.1016\/j.hpb.2016.02.001","article-title":"Incisional hernia after open resections for colorectal liver metastases - incidence and risk factors.","volume":"18","author":"Nilsson","year":"2016","journal-title":"HPB (Oxford)"},{"issue":"1","key":"soi260060r5","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1159\/000521169","article-title":"Prevention of Incisional Hernia after Open Hepato-Pancreato-Biliary Surgery: A Systematic Review.","volume":"39","author":"Memba","year":"2022","journal-title":"Dig Surg"},{"issue":"22","key":"soi260060r6","doi-asserted-by":"publisher","first-page":"1998","DOI":"10.1001\/jama.2025.4347","article-title":"CONSORT 2025 Statement: Updated Guideline for Reporting Randomized Trials.","volume":"333","author":"Hopewell","year":"2025","journal-title":"JAMA"},{"issue":"1","key":"soi260060r7","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s10029-014-1342-5","article-title":"European Hernia Society guidelines on the closure of abdominal wall incisions.","volume":"19","author":"Muysoms","year":"2015","journal-title":"Hernia"},{"issue":"2","key":"soi260060r8","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1097\/SLA.0b013e3181b13ca2","article-title":"The Clavien-Dindo classification of surgical complications: five-year experience.","volume":"250","author":"Clavien","year":"2009","journal-title":"Ann Surg"},{"issue":"1","key":"soi260060r11","doi-asserted-by":"publisher","DOI":"10.1093\/bjsopen\/zrae145","article-title":"Primary ventral and incisional hernias: comprehensive review.","volume":"9","author":"Henriksen","year":"2025","journal-title":"BJS Open"},{"issue":"1","key":"soi260060r12","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1007\/s10029-020-02348-7","article-title":"Preventing incisional ventral hernias: important for patients but ignored by surgical specialities? a critical review.","volume":"25","author":"Garcia-Urena","year":"2021","journal-title":"Hernia"},{"issue":"6","key":"soi260060r13","doi-asserted-by":"publisher","first-page":"1115","DOI":"10.1007\/s11605-008-0469-z","article-title":"Outcome of and risk factors for incisional hernia after partial hepatectomy.","volume":"12","author":"Togo","year":"2008","journal-title":"J Gastrointest Surg"},{"issue":"5","key":"soi260060r14","doi-asserted-by":"publisher","first-page":"701","DOI":"10.1002\/ags3.12467","article-title":"Risk factors for incisional hernia according to different wound sites after open hepatectomy using combinations of vertical and horizontal incisions: A multicenter cohort study.","volume":"5","author":"Iida","year":"2021","journal-title":"Ann Gastroenterol Surg"},{"issue":"2","key":"soi260060r15","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1001\/archsurg.140.2.119","article-title":"Smoking is a risk factor for incisional hernia.","volume":"140","author":"S\u00f8rensen","year":"2005","journal-title":"Arch Surg"},{"issue":"4","key":"soi260060r16","doi-asserted-by":"publisher","first-page":"405","DOI":"10.1016\/j.jamcollsurg.2014.12.027","article-title":"Development and validation of a risk stratification score for ventral incisional hernia after abdominal surgery: hernia expectation rates in intra-abdominal surgery (the HERNIA Project).","volume":"220","author":"Goodenough","year":"2015","journal-title":"J Am Coll Surg"},{"issue":"2","key":"soi260060r17","doi-asserted-by":"publisher","first-page":"188","DOI":"10.1002\/lt.22445","article-title":"Early use of mammalian target of rapamycin inhibitors is an independent risk factor for incisional hernia development after liver transplantation.","volume":"18","author":"Montalti","year":"2012","journal-title":"Liver Transpl"},{"issue":"10094","key":"soi260060r18","doi-asserted-by":"publisher","first-page":"567","DOI":"10.1016\/S0140-6736(17)31332-6","article-title":"Prevention of incisional hernia with prophylactic onlay and sublay mesh reinforcement versus primary suture only in midline laparotomies (PRIMA): 2-year follow-up of a multicentre, double-blind, randomised controlled trial.","volume":"390","author":"Jairam","year":"2017","journal-title":"Lancet"},{"issue":"12","key":"soi260060r19","doi-asserted-by":"publisher","first-page":"1239","DOI":"10.1093\/bjs\/znac302","article-title":"Updated guideline for closure of abdominal wall incisions from the European and American Hernia Societies.","volume":"109","author":"Deerenberg","year":"2022","journal-title":"Br J Surg"},{"issue":"5","key":"soi260060r20","doi-asserted-by":"publisher","first-page":"1358","DOI":"10.1016\/j.surg.2016.05.010","article-title":"Prophylactic mesh can be used safely in the prevention of incisional hernia after bilateral subcostal laparotomies.","volume":"160","author":"Bl\u00e1zquez Hernando","year":"2016","journal-title":"Surgery"},{"issue":"3","key":"soi260060r21","doi-asserted-by":"publisher","first-page":"741","DOI":"10.1007\/s00268-019-05282-7","article-title":"Incidence of Incisional Hernia After Emergency Subcostal Unilateral Laparotomy: Does Augmentation Prophylaxis Play a Role?","volume":"44","author":"Bravo-Salva","year":"2020","journal-title":"World J Surg"},{"key":"soi260060r9"},{"key":"soi260060r10","doi-asserted-by":"crossref","unstructured":"Muysoms? FE. Vanlander? A, Ceulemans? R, Kyle-Leinhase? I, Michiels? M, Jacobs? I, Pletinckx? P, Berrevoet? F. (2016) A prospective, multicenter, observational study on quality of life after laparoscopic inguinal hernia repair with ProGrip laparoscopic, self-fixating mesh according to the European Registry for Abdominal Wall Hernias Quality of Life Instrument.? Surgery. 2025;160(5):1344-1357.","DOI":"10.1016\/j.surg.2016.04.026"}],"container-title":["JAMA Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamasurgery\/articlepdf\/2853952\/jamasurgery_bellidoluque_2026_oi_260060_1788536063.36065.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T15:00:31Z","timestamp":1788966031000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamasurgery\/fullarticle\/2853952"}},"subtitle":["A Randomized Clinical Trial"],"short-title":[],"issued":{"date-parts":[[2026,9,9]]},"references-count":21,"URL":"https:\/\/doi.org\/10.1001\/jamasurg.2026.4012","relation":{},"ISSN":["2168-6254"],"issn-type":[{"value":"2168-6254","type":"print"}],"subject":[],"published":{"date-parts":[[2026,9,9]]}}}