We have to know the risk and prevention methods of abdominal incisional hernia depends on approach of gastric surgeries. The prevention of surgical site infection could also prevent abdominal incisional hernia due to strong correlation between surgical site infection and abdominal incisional hernia. Although there is not sufficient data for prevention of abdominal incisional hernia limited in gastric surgery, single layer aponeurotic closure of midline abdominal wall incision using slowly absorbable suture material have been recommended in Europe. The incidence of abdominal incisional hernia would decrease by laparoscopic approach comparing open gastrectomy. However, we should pay attention to port site hernia after laparoscopic surgery.

Incisional hernia is one of the most common postoperative wound complications. 6 of the 70 patients with hepatocellular carcinoma who underwent laparoscopic hepatectomy in our hospital from 2018 to 2020 had incisional hernias, with an incidence rate of 8.6％. Obesity, wound infection, and postoperative ascites were the most common backgrounds of the cases, and most of them prolapsed from the upper midline or the site of excised specimen. As a risk factor, postoperative ascites was observed, and there was a tendency for SSI to occur in many cases. In order to recognize the risks and perform evidence-based abdominal wall closure methods and preventive measures, this paper describes preventive measures for abdominal wall incisional hernia, focusing on recent findings, including the results of a risk survey in our own case.

[Background] Incisional hernia is one of the most frequent postoperative complications after midline abdominal incision surgery. The frequency is reported to be even higher for abdominal aortic aneurysm surgery. We investigated the incidence of incisional hernia after abdominal aortic aneurysm surgery at our hospital, and examined the risk factors. [Methods] In this study, we investigated the incidence of postoperative incisional hernia in patients with abdominal aortic aneurysms who underwent abdominal aortic aneurysm replacement through a midline abdominal incision between January 2015 and August 2020. Perioperative factors were compared between two groups: 16 patients in the group with postoperative incisional hernia (group H) and 84 patients in the group without incisional hernia (group N). [Results] The results showed that the proportion of patients aged 75 years or older was higher in the H group. The incidence of COPD was significantly higher in group H, and the incidence of SSI was higher. Multivariate analysis showed that elderly patients over 75 years old and COPD were independent risk factors. [Conclusion] The incidence of incisional hernia after abdominal aortic aneurysm surgery at our hospital was 16％, and the risk factors were age over 75 years and COPD incidence.

Several evidences have been established for procedures to reduce postoperative complications, centering on clean and clean-contaminated wounds, regarding abdominal wall closure. However, there are not many studies on contaminated or dirty wounds that are common in emergency surgery. In this paper, we discuss several procedures such as absorbable/non-absorbable sutures, antimicrobial-coated sutures, irrigation, subcutaneous drains, skin closures, and negative pressure wound therapy, which are applied to clean or clean-contaminated wounds. Also, we checked whether these studies included the patients with dirty or infected wound. Regarding wound closure in emergency (contaminated) surgery, it is important to understand the evidence supporting the procedures performed in elective surgery (clean/clean-contaminated wound), and recognize whether the results can be extrapolated to contaminated/dirty wound. In addition, it is important to constantly update our daily practice with new information, as there is currently a lack of evidence and many techniques are still unstandardized.