Incisional hernia (IH) remains one of the most frequent complications following midline laparotomy, with an overall prevalence of approximately 10% and markedly higher rates in high-risk populations. Despite advances in surgical technique, prevention strategies are not uniformly implemented, particularly in emergency settings where patient-related risk factors are compounded.
Recent evidence highlights the importance of risk stratification. Surgical site infection and reoperation represent the most significant contributors to IH development, supporting a targeted and individualized preventive approach. Prophylactic mesh reinforcement has consistently demonstrated a reduction in IH incidence across meta-analyses; however, its clinical adoption remains limited due to increased risks of seroma and surgical site infection, as well as heterogeneity in study design and patient populations. Notably, randomized data in emergency laparotomy settings remain inconclusive, emphasizing the need for further investigation in high-risk cohorts.
Technical aspects of abdominal wall closure continue to play a central role. The small-stitch technique and meticulous tissue handling are key principles, with emerging technologies suggesting potential benefits in reducing tissue trauma and standardizing closure. In complex abdominal wall reconstruction, innovative approaches such as intraoperative fascial traction may facilitate high rates of primary fascial closure while reducing the need for extensive component separation.
Overall, a multimodal and risk-adapted strategy integrating optimized closure techniques, selective mesh reinforcement, and advanced reconstructive concepts appears essential. Future research should focus on high-quality randomized trials, standardized methodologies, and patient-centered outcomes to refine prevention strategies and improve clinical implementation.
Statements
Author contributions
RF contributed substantially to the conceptualization of the manuscript, literature review, drafting and critical revision of the manuscript, and approved the final version for publication. NH contributed to manuscript preparation, critical revision, and approval of the final manuscript. All authors contributed to the article and approved the submitted version.
Funding
The author(s) declared that financial support was not received for this work and/or its publication.
Conflict of interest
The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Generative AI statement
The author(s) declared that generative AI was not used in the creation of this manuscript.
Any alternative text (alt text) provided alongside figures in this article has been generated by Frontiers with the support of artificial intelligence and reasonable efforts have been made to ensure accuracy, including review by the authors wherever possible. If you identify any issues, please contact us.
Publisher’s note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
Summary
Keywords
AW-closure, hernia prevention, laparotomy, midline closure, small bites
Citation
Fortelny RH and Henriksen NA (2026) Editorial: Closure of abdominal wall - status Quo. J. Abdom. Wall Surg. 5:16896. doi: 10.3389/jaws.2026.16896
Received
05 May 2026
Accepted
11 May 2026
Published
20 May 2026
Volume
5 - 2026
Updates
Copyright
© 2026 Fortelny and Henriksen.
This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: René H. Fortelny, dr.fortelny@gmail.com
Disclaimer
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.