Supplementary Material for: PREVENTION OF INCISIONAL HERNIA AFTER OPEN HEPATO-PANCREATO-BILIARY SURGERY: A SYSTEMATIC REVIEW

Introduction Most hepato-pancreato-biliary (HPB) procedures are still performed through open approach. Incisional hernia (IH) is one of the most common complications after open surgery. To date, published data on IH after HPB surgery are scarce, therefore the aim of this study was to assess the current evidence regarding incidence, risk factors, and prevention. Methods Medline/PubMed (1946-2020), EMBASE (1947-2020), and the Cochrane library (1995-2020)) were searched for studies on IH in open HPB surgery. Animal studies, editorials, letters, reviews, comments, short case series and liver transplant, laparoscopic or robotic procedures were excluded. The protocol was registered with PROSPERO (CRD42020163296). Results A total of 5 079 articles were retrieved. 8 studies were finally included for the analysis. The incidence of IH after HPB surgery ranges from 7.7% to 38.8%. The identified risk factors were body mass index, surgical site infection, ascites, Mercedes or reversed T incisions and previous IH. Prophylactic mesh might be safe and effective. Conclusions IH after open HPB surgery is still an important matter. Some of the risk factors are specific for the HPB operations and the incision type should be carefully considered. Randomised controlled trials are required to confirm the role of prophylactic mesh after HPB operations.