Surgical mesh layered over abdomen

Mesh vs. Sutures: Which Closure Method Best Prevents Hernias After Surgery?

Beau Callahan in Health & Wellness December 2025 • 4 min read.

"A new meta-analysis examines the effectiveness of prophylactic mesh in reducing incisional hernias compared to standard suture closure."

Incisional hernias are a common and frustrating complication following laparotomy, affecting between 5% and 20% of patients who undergo this type of surgery. These hernias can lead to a range of issues, from bowel obstruction and strangulation to a significant decrease in quality of life. While surgical repair is an option, recurrence rates can be high, making prevention a key focus.

Traditionally, surgeons have closed midline incisions using sutures, a technique that involves stitching the abdominal wall together. However, recent research suggests that adding a prophylactic mesh—a supportive material placed under the skin—may reduce the risk of hernia development. This approach is gaining traction, but questions remain about its effectiveness and potential drawbacks.

A new meta-analysis, published in the journal Hernia, dives deep into this debate. Researchers analyzed data from multiple randomized controlled trials, comparing the outcomes of patients who received prophylactic mesh versus those who underwent standard suture closure. The goal? To provide a clearer understanding of whether mesh can truly help prevent incisional hernias.

Does Prophylactic Mesh Really Reduce Hernias?

The meta-analysis included eight studies with a total of 727 patients. The results showed a significant reduction in the occurrence of incisional hernias in the mesh group compared to the suture repair group. Specifically, the odds ratio (OR) was 0.14, with a 95% confidence interval of 0.07 to 0.27. This means that patients who received prophylactic mesh were significantly less likely to develop a hernia after laparotomy.

However, the study also revealed some potential downsides. There was a significant increase in the number of seromas—fluid collections under the skin—in the mesh group compared to the suture repair group (OR 1.73, 95% CI 1.04–2.87). Additionally, the operative time was significantly longer in the mesh group (standardized mean difference [SMD] 0.24, 95% CI 0.00–0.48).

Reduced Hernia Risk: Prophylactic mesh significantly lowers the chances of developing an incisional hernia.
Increased Seroma Risk: Mesh placement is associated with a higher incidence of seromas.
Longer Operative Time: Surgeries involving mesh tend to take longer to perform.

It's important to note that the majority of patients included in the analyzed studies were considered to be at high risk of developing incisional hernias. This suggests that the benefits of prophylactic mesh may be most pronounced in this specific population. However, two of the included studies did not limit their inclusion to high-risk patients, and both still found that prophylactic mesh reduced the incidence of IH.

Weighing the Pros and Cons

This meta-analysis provides compelling evidence that prophylactic mesh can be an effective tool in preventing incisional hernias, particularly in high-risk patients. However, the increased risk of seromas and longer operative times must also be considered. Ultimately, the decision of whether to use prophylactic mesh should be made on a case-by-case basis, taking into account the individual patient's risk factors, overall health, and preferences. Further research is needed to determine the long-term outcomes of prophylactic mesh placement and to identify strategies for minimizing the risk of complications.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1007/s10029-017-1653-4, Alternate LINK

Title: Meta-Analysis Of Randomised Trials Comparing The Use Of Prophylactic Mesh To Standard Midline Closure In The Reduction Of Incisional Herniae

Subject: Surgery

Journal: Hernia

Publisher: Springer Science and Business Media LLC

Authors: R. Payne, J. Aldwinckle, S. Ward

Published: 2017-09-01

Everything You Need To Know

What are incisional hernias and why are they a problem?

Incisional hernias occur after surgery, specifically laparotomies, where an incision is made in the abdomen. They appear in 5% to 20% of patients and can cause bowel obstruction, strangulation, and a lower quality of life. Prevention is key, as recurrence rates after surgical repair can be high. The meta-analysis looked at ways to prevent these hernias.

What are sutures and prophylactic mesh, and how do they relate to hernia prevention?

Surgeons traditionally close incisions using sutures, which involves stitching the abdominal wall together. Prophylactic mesh is a supportive material placed under the skin. The meta-analysis compared the outcomes of using prophylactic mesh versus standard suture closure to determine if mesh can help prevent incisional hernias.

What did the meta-analysis find about the effectiveness of prophylactic mesh in preventing hernias?

The meta-analysis showed that using prophylactic mesh significantly reduced the occurrence of incisional hernias compared to suture repair alone. Specifically, patients who received prophylactic mesh were significantly less likely to develop a hernia after laparotomy. The odds ratio was 0.14, with a 95% confidence interval of 0.07 to 0.27. However, it's important to consider that the majority of patients included in the analyzed studies were considered to be at high risk of developing incisional hernias.

Are there any downsides to using prophylactic mesh?

While prophylactic mesh can reduce the risk of incisional hernias, it's associated with an increased risk of seromas, which are fluid collections under the skin. The meta-analysis found a significant increase in seromas in the mesh group compared to the suture repair group. Additionally, surgeries involving mesh tend to take longer to perform.

How should doctors decide whether to use prophylactic mesh for their patients?

The decision to use prophylactic mesh should be made on a case-by-case basis, considering the individual patient's risk factors, overall health, and preferences. Prophylactic mesh may be most beneficial for high-risk patients. Further research is needed to determine the long-term outcomes of prophylactic mesh placement and strategies for minimizing complications.