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Risk factors for developing incisional herniae

1. Surgical
   • Careless suturing
   • Inappropriate material
2. Local
   • Haematoma
   • Infection
3. Patient
   • Malnutrition
   • Obesity
   • Jaundice
   • Immunosuppression

Procedure for repair

1. Optimise patient pre-operatively (repair often fails)
2. GA + supine
3. Dissect down to hernia
   • Incision made over hernia
   • Hernia sac dissected out
   • Incision deepened around margins og hernia until healthy aponeurosis identified
4. Reduce hernia
   • Sac opened
   • Contents returned to peritoneal cavity
5. Close defect
   • if < 4cm can be closed with interrupted nylon
   • If large: close with tension-free Prolene mesh repair sutured to anterior rectus sheath with interrupted absorable sutures at 2cm intervals
6. Finish