AUTHOR=Lozada Hernandez Edgard Efren , Fernandez Vázquez-Mellado Luis Alberto , Martin-del-Campo Luis A. , Valenzuela Alpuche Héctor Ali , Jean Silver Enrique Ricardo , Rodríguez H. Alejandro , Reynoso González Ricardo , Prado Salcedo Tatiana Andrea , Martinez-Zamorano Monserrat , Pleoneda Valencia Cesar Felipe 
  
TITLE=Systematic Review and Meta-Analysis of the Prevalence and Risk Factors Associated With the Occurrence of Incisional Hernia in Patients Undergoing Midline Laparotomy
  
JOURNAL=Journal of Abdominal Wall Surgery
  
VOLUME=Volume 5 - 2026
  
YEAR=2026
  
URL=https://www.frontierspartnerships.org/journals/journal-of-abdominal-wall-surgery/articles/10.3389/jaws.2026.15439
  
DOI=10.3389/jaws.2026.15439
  
ISSN=2813-2092
  
ABSTRACT=IntroductionIncisional hernia (IH) is the main long-term complication after midline laparotomy and has significant clinical and economic effects. Although multiple risk factors for IH formation have been proposed, their ranking and clinical relevance have not been clearly established. This meta-analysis aimed to estimate the prevalence of IH and rank the associated risk factors, considering both their statistical significance and their clinical impact.MethodsThis meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered in PROSPERO (CRD420251107739). Observational (cohort and cross-sectional) studies evaluating patients undergoing midline laparotomy with follow-up for IH were included. Clinical trials and studies involving a laparoscopic approach were excluded. The global prevalence of IH was calculated, and random effects models were used to identify risk factors associated with the occurrence of IH, whose associations are reported as hazard ratios (HRs) and 95% confidence intervals.ResultsTwenty studies (n = 790,800 patients) were included, among whom the overall prevalence of IH was 10.1% (95% CI: 7%–15%). Only 10 studies analyzed relevant risk factors. The factors with the greatest clinical impact were reoperation during hospitalization (HR = 4.09) and surgical site infection (HR = 2.96). Other significant factors included emergency surgery, colon surgery, stoma creation, diabetes, and liver disease. Factors such as sex, obesity, or hypertension were not significantly associated with IH formation.ConclusionsPerioperative factors are key determinants of the occurrence of IH. The identification of such factors would allow prioritization of preventive interventions, such as the application of prophylactic meshes, especially in high-risk patients. Standardized prospective studies are needed to validate these findings.