Prevention of Fascial Dehiscence With Prophylactic Onlay Mesh in Emergency Laparotomies

Inclusion Criteria: * Emergency laparotomy by midline incision * High risk for abdominal wound dehiscence: Risk index\*\* ≥ 4,0 or ≥ 2,2 in combination with at least one of the following: smoking, obesity, malnutrition or malignant neoplasia. * Risk index is the sum of values associated with high-risk characteristics, based in the risk score for abdominal wall dehiscence published by van Ramshorst et. al. in World Journal of Surgery, 2010 (Rotterdam risk model): Age category (in years) * 40-49: 0.4 * 50-59: 0.9 * 60-69: 0.9 * ≥70: 1.1 Male gender: 0.7 Chronic pulmonary disease: 0.7 Ascites: 1.5 Jaundice: 0.5 Anemia: 0.7 Emergency surgery: 0.6 Type of surgery: * Gallbladder/bile duct 0.7 * Esophagus 1.5 * Gastroduodenum 1.4 * Small bowel 0.9 * Large bowel 1.4 * Vascular 1.3 Exclusion Criteria: * Non-midline incisions or midline laparotomy measuring less than 1/4 the distance between the xyphoid and the pubis, including laparoscopic surgery. * Diagnosis of incisional hernia or presence of previous mesh on site. * Midline laparotomy performed in less than 30 days. * Pregnancy * Severe trauma with hemodynamic instability * Need for open abdomen or relaxing incisions * Need for re-laparotomy during the first 30 postoperative days, except cases in which an abdominal wall dehiscence was diagnosed. * Death during the first 30 postoperative days, except cases in which an abdominal wall dehiscence was diagnosed before the event.