Background <p>Open abdomen is indicated in some clinical scenarios, but it introduces new challenges like the development of planned incisional hernias; new management techniques for temporary closure in open abdomen such as negative pressure wound therapy and mesh-mediated fascial traction have shown an incidence reduction of this outcome. However, for successful abdominal wall closure rates, there is limited evidence evaluating the factors associated with it when mesh-mediated fascial traction is employed in the context of open abdomen.</p> Methods <p>We conducted a retrospective cohort analysis of patients managed with mesh-mediated fascial traction at Méderi Hospital Network from 2020 to 2025. Demographic data, clinical characteristics, surgical variables, and postoperative outcomes were systematically evaluated.</p> Results <p>Ninety-two patients were included, achieving a definitive abdominal wall closure success rate of 70.7%. Closure failure was significantly correlated with more than four peritoneal lavage procedures, intestinal resection, and initial fascial defects greater than 7.5&#xa0;cm. Primary indications for OA management were peritonitis/sepsis (34.8%) and bowel obstruction (19.6%).</p> Conclusions <p>Mesh-mediated fascial traction is effective for definitive abdominal wall closure in a majority of patients. However, identifying those at increased risk for closure failure is vital. Utilizing a tailored decision-making algorithm based on specific predictors can optimize clinical outcomes and reduce healthcare costs.</p>