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Incisional Hernia (Viva (Hx (Previous surgery, Post-operative wound…

- - - - Manage RFs: e.g. constipation, cough
      - Weight loss
      - Elasticated corset or truss
    - - Pre-Op
        Optimise cardiorespiratory function
        Encourage wt. loss
      - Nylon mesh repair: open or lap
  - - - Surgical technique/skill (major factor)
      - Too small suture bites
      - Inappropriate suture material
      - Incision type (e.g. midline)
      - Placing drains through wounds
    - - ↑ IAP: chronic cough, straining, post-op ileus
      - Infection
      - Haematoma
    - - ↑ age
      - Comorbidities: DM, renal failure
      - Drugs: steroids, chemo, radio
      - Obesity or malnutrition
      - Malignancy
- - - - Ask pt. to lift head off bed
      - Ask pt. to cough
- - - - Manage RFs: e.g. constipation, cough
      - Weight loss
    - - Reduce hernial contents and excise sac
      - Suture or mesh repair
  - - - May be asymptomatic
      - May be confused for upper GI pathology
      - Pain: may ↑ after meals or exercise
      - Nausea and early satiety
      - Abdominal bloating
  - - - Predisposing factors: pregnancy, obesity
      - Symptoms
      - Reducible
      - Episodes of obstruction or strangulation
      - Previous repairs
- - - - Widening of gap between recti muscles
      - Not a hernia