AUTHOR=Lozada Hernandez Edgard Efren , Fernández-Vázquez-Mellado Luis Alberto , Reynoso Gonzalez Ricardo , Martin-del-Campo Luis A. , Valenzuela Alpuche Hector Ali , Rodríguez H. Alejandro , Jean Silver Enrique Ricardo , Ploneda Valencia Cesar Felipe , Serna Murga Marian , Martinez Gonzalez Gloria Valeria 
  
TITLE=Efficacy and Safety of Prophylactic Mesh Reinforcement for the Prevention of Incisional Hernia: An Umbrella Review of Meta-Analyses
  
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.2026.15631
  
DOI=10.3389/jaws.2026.15631
  
ISSN=2813-2092
  
ABSTRACT=IntroductionIncisional 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.MethodsA 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.ResultsTwenty-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.ConclusionProphylactic 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.