Tela Profilática: Vale a Pena Colocar na Primeira Cirurgia?

Evisceration and incisional hernia remain frequent complications after a median laparotomy. Depending on the population studied, their incidence can exceed 20%, and in high-risk patients, this number may be even higher. Beyond the aesthetic impact, incisional hernias are associated with chronic pain, functional limitations, reduced quality of life, and the need for further surgeries, often more complex than the initial procedure. In recent years, several studies have investigated a simple, yet controversial, strategy: the placement of a prophylactic mesh at the time of laparotomy closure, even before the development of any hernia. The proposal is to reinforce the abdominal wall during healing, reducing the incidence of incisional hernia and possibly also aponeurosis dehiscence and evisceration in selected patients. But does this strategy really work? Which patients benefit? And what are the risks associated with the routine placement of a mesh? In this video, we analyze the main scientific evidence available on the subject, including randomized clinical trials, systematic reviews, and international recommendations. We discuss which patients are at higher risk for abdominal wall complications, such as obesity, abdominal aortic aneurysm, smoking, emergency surgery, infection, malnutrition, chronic use of corticosteroids, and other conditions that compromise healing. We also address one of the most important points in clinical practice: not every laparotomy requires prophylactic mesh. The benefit seems to be concentrated in carefully selected patients in whom the risk of hernia outweighs the potential risk of implant-related complications. Another aspect discussed is the ideal mesh placement. Currently, there are several possibilities, including retromuscular, preperitoneal, onlay, and intraperitoneal placement, each with advantages and technical limitations. The choice depends on the anatomy, the surgery performed, the team's experience, and the type of mesh used. In addition to efficacy, we also analyze possible adverse effects. The fear of increased surgical site infection, seromas, chronic pain, or the need for mesh removal has always accompanied this strategy. However, the most recent studies help to put these risks into perspective and show that, when well indicated and correctly implanted, prophylactic mesh can present a very favorable safety profile. Finally, we discuss how this strategy can change the practice of the general surgeon. Instead of treating a hernia years after the initial surgery, it may be possible to prevent it during the first procedure, reducing morbidity, reoperations, and costs for the healthcare system. If you perform median laparotomies or follow up with patients post-operatively, this video provides a practical and evidence-based review of one of the most current topics in abdominal wall surgery. The question that remains is simple: Are we missing the opportunity to prevent a hernia before it even happens?