Patient selection: incrisional ventral hernia repair
Management of co-morbid conditions:
(1) smoking cessation
(2) correction of malnutrition
(3) optimum glucose control if diabetic
If the person is severely obese and if surgery is elective then a weight loss program prior to surgery should be considered.
If the person is deconditioned then the patient should be started on an exercise program (a recommendation not in the paper).
If the patient is immunosuppressed or immunocompromised then any contributing conditions must be evaluated for their impact on surgery. If these cannot be controlled and if the patient is at risk for infection then surgery may need to be deferred.
(1) Discontinuation of corticosteroids or other immunosuppressing medications if possible.
(2) Control of conditions contributing to immunocompromise if possible.
If the patient has infections or fistula then these need to be managed prior to surgery or surgery may need to be performed in a staged approach.
(1) infected mesh needs to be removed
(2) abscesses need to be drain
(3) fistulae need to be excised, reanastomosed or externalized
(4) devitalized tissue needs to be debrided
(5) adhesions need to be taken down
