- Vertical or curvilinear incision over or adjacent to the hernia sac
- Hernia sac dissected to its fascial attachments
- Once the fascia has been cleared, the hernia sac can either be inverted or excised
- Fascia subsequently closed with a non-absorbable suture
- If defect large or if the fascial edges cannot be approximated without tension, mesh should be used
- Consider mesh for all incisional hernias or > 1cm in diameter
- Mesh placed deep to (sublay or underlay) or over the fascia (onlay) and should be sutured circumferentially to the surrounding fascia to prevent migration
- Effort should be made to tack the skin of the umbilicus to the fascia to recreate a cosmetically appealing umbilicus