Collagen-Stratified Abdominal Wall Closure Combined with Subaponeurotic Platelet-Rich Plasma: Feasibility and Early Incidence of Postoperative Ventral Hernia in a Prospective, Uncontrolled Single-Centre Cohort

Background: Fascial healing depends on type I collagen, yet collagen metabolism is rarely considered when choosing an abdominal wall closure technique. Objective: to describe the early incidence of postoperative ventral hernia (PVH) after closure stratified by preoperative collagen biomarkers and combined with subaponeurotic platelet-rich plasma (PRP). Methods: Prospective single-centre cohort of 106 consecutive adults (October 2024–December 2025) undergoing elective hernia repair (n = 61) or other abdominal surgery (n = 45). Serum P1NP and CTX-I defined low (n = 35), moderate (n = 27) and high (n = 44) collagen groups. Mesh was used in all low-collagen patients, in 12 moderate-collagen patients and in no high-collagen patients; all patients received PRP. Incidence was reported with Wilson 95% confidence intervals (CIs); groups were compared with exact tests, Welch’s ANOVA and multinomial regression. Results: One PVH occurred (0.9%; 95% CI 0.2–5.2%), a recurrence after mesh repair in the low-collagen group. Upper confidence limits were 12.5% and 8.0% in the moderate- and high-collagen groups. Lower collagen category was associated with older age (OR for high vs. low 0.30 per 10 years; 95% CI 0.18–0.52) and with cardiovascular comorbidity. There were no deep infections, mesh removals or deaths. Conclusions: The protocol was feasible and early PVH was rare. Because every patient received PRP, mesh use followed the collagen group and follow-up was short, these data cannot show that either component prevents PVH; a randomised trial is needed.