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Implementing a protocol to prevent incisional hernia in high-risk patients : a mesh is a powerful tool Pereira-Rodríguez, José Antonio Amador Gil, Sara Bravo-Salva, Alejandro Montcusí-Ventura, B. Sancho Insenser, Joan Josep Pera-Román, M. López Cano, Marc Universitat Autònoma de Barcelona Abdominal wall closure Laparotomy closure Incisional hernia Small bites Short stitch Prophylactic mesh The small bites (SB) technique for closure of elective midline laparotomies (EMLs) and a prophylactic mesh (PM) in high-risk patients are suggested by the guidelines to prevent incisional hernias (IHs) and fascial dehiscence (FD). Our aim was to implement a protocol combining both the techniques and to analyze its outcomes. Prospective data of all EMLs were collected for 2 years. Results were analyzed at 1 month and during follow-up. The incidence of HI and FD was compared by groups (M = Mesh vs. S = suture) and by subgroups depending on using SB. A lower number of FD appeared in the M group (OR 0.0692; 95% CI 0.008-0.56; P = 0.01) in 197 operations. After a mean follow-up of 29.23 months (N = 163; min. 6 months), with a lower frequency of IH in M group (OR 0.769; 95% CI 0.65-0.91; P < 0.0001). (33) The observed differences persisted after a propensity matching score: FD (OR 0.355; 95% CI 0.255-0.494; P < 0.0001) and IH (OR 0.394; 95% CI 0.24-0.61; P < 0.0001). On comparing suturing techniques by subgroups, both mesh subgroups had better outcomes. PM was the main factor related to the reduction of IH (HR 11.794; 95% CI 4.29-32.39; P < 0.0001). Following the protocol using PM and SB showed a lower rate of FD and HI. A PM is safe and effective for the prevention of both HI and FD after MLE, regardless of the closure technique used. 2021 Article https://ddd.uab.cat/record/292284 urn:10.1007/s10029-021-02527-0 urn:oai:ddd.uab.cat:292284 urn:pmcid:PMC9012727 urn:pmc-uid:9012727 urn:pmid:34724119 urn:oai:pubmedcentral.nih.gov:9012727 urn:articleid:12489204v26p457 urn:oai:egreta.uab.cat:publications/00b2593a-902e-4ebd-897a-2c4d9e4a374f eng Hernia ; Vol. 26 (november 2021), p. 457-466 open access Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original. https://creativecommons.org/licenses/by/4.0/ application/pdf