Wound dehiscence and incisional hernia after laparotomy: A narrative review of risk factors and management approaches

Wound dehiscence (WD) and incisional hernia (IH) are common and serious complications following laparotomy, resulting in increased morbidity, mortality, and healthcare costs. This review highlights key patient-related risk factors such as high body mass index, obesity, malnutrition, anemia, diabetes mellitus, advanced age, and male sex, alongside surgical and post-operative contributors, including surgical site infection, emergency surgery, ostomy creation, pulmonary complications, and poor surgical technique. Previous laparotomy, high American Society of Anesthesiologists scores, and certain suture materials also influence risk. Prevention strategies emphasize pre-operative optimization of patient health, meticulous surgical techniques, and the use of modified closure methods such as reinforced tension line and retention sutures, which significantly reduce incidence rates without increasing post-operative complications. Infection control and nutritional management remain critical. Prophylactic mesh use in high-risk patients shows promise for reducing IH. Management approaches vary from conservative care for WD to open or laparoscopic repair for IH, with laparoscopic methods offering lower infection and recurrence rates. Emerging predictive tools, including artificial intelligence models, enhance risk stratification and clinical decision-making. Overall, comprehensive prevention and individualized management strategies are essential to improve outcomes and reduce the burden of these complications after laparotomy.