TY - JOUR AU - Medina Pedrique, Manuel AU - Robin Valle de Lersundi, Álvaro AU - Avilés Oliveros, Adriana AU - Ruiz, Sara Morejón AU - López-Monclús, Javier AU - Munoz-Rodriguez, Joaquín AU - Blázquez Hernando, Luis Alberto AU - Martinez Caballero, Javier AU - García-Urena, Miguel Ángel PY - 2023 M3 - Review TI - Incisions in Hepatobiliopancreatic Surgery: Surgical Anatomy and its Influence to Open and Close the Abdomen JO - Journal of Abdominal Wall Surgery UR - https://www.frontierspartnerships.org/articles/10.3389/jaws.2023.11123 VL - 2 SN - 2813-2092 N2 - Incisions performed for hepato-pancreatic-biliary (HPB) surgery are diverse, and can be a challenge both to perform correctly as well as to be properly closed. The anatomy of the region overlaps muscular layers and has a rich vascular and nervous supply. These structures are fundamental for the correct functionality of the abdominal wall. When performing certain types of incisions, damage to the muscular or neurovascular component of the abdominal wall, as well as an inadequate closure technique may influence in the development of long-term complications as incisional hernias (IH) or bulging. Considering that both may impair quality of life and that are complex to repair, prevention becomes essential during these procedures. With the currently available evidence, there is no clear recommendation on which is the better incision or what is the best method of closure. Despite the lack of sufficient data, the following review aims to correlate the anatomical knowledge learned from posterior component separation with the incisions performed in hepato-pancreatic-biliary (HPB) surgery and their consequences on incisional hernia formation. Overall, there is data that suggests some key points to perform these incisions: avoid vertical components and very lateral extensions, subcostal should be incised at least 2 cm from costal margin, multilayered suturing using small bites technique and consider the use of a prophylactic mesh in high-risk patients. Nevertheless, the lack of evidence prevents from the possibility of making any strong recommendations. ER -