Postoperative abdominal incision failure remains as much a problem and topic of controversy today as it did nearly a century ago. The predominance of the surgical literature on incisional hernia describes and evaluates various repair techniques; less is written on predisposition and prevention. In the latter subset of the literature, emphasis has been placed upon patient-associated risk factors in the pathogenesis of incisional failure. Over the past several decades, however, the idea that surgeon-associated (i.e., technical) risk factors may be important in the etiology of incisional hernia has been gaining more acceptance . The postulation that the surgeon could be the most important risk factor for this complication, however, is a more radical concept. This brief review will emphasize the role of surgeon-related factors in the development of incisional hernia.
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