Consider the hypothetical case of a middle-aged patient who presents to a general surgery clinic to be evaluated for an incisional hernia. He lives a very active lifestyle and maintains an athlete’s level of fitness but required a laparotomy a few years ago. He presented to the surgical clinic recently to be evaluated for a large incisional hernia that developed in the weeks following his operation. There are no obvious risk factors for him to have developed an incisional hernia as he does not have obesity, is not a smoker, takes no medications, and did not have any wound complications after his operation. Why did this happen? Reviewing the operative reports yields only that his incision was closed in a common fashion using a running 0-looped absorbable suture, a common laparotomy closure.