Aetiology

Predisposing factors to incisional herniae may occur singly or together. These include:

• poor surgical technique - inadequate fascial bites, tension on the fascial edges, or too tight a closure
• post-operative wound infection
• age - healing is slower in older patients
• general debility - cirrhosis, carcinoma, and chronic wasting diseases affect wound healing
• obesity - fat patients have a raised intra-abdominal pressure
• type of incision used - many surgeons believe that transverse and oblique wounds heal better than vertical ones
• post-operative pulmonary complications that stress the repair as a result of vigorous coughing. Smokers and patients with chronic pulmonary disease have the greatest risk.
• placement of drains or stomas in the primary operative wound
• failure to use non-absorbable suture material
• failure to pay proper attention to protein nutrition and vitamin C
• catabolism due to sepsis slows wound healing
• steroid use
• diabetes mellitus
• collagen disorders