**Core Concept**
The surgical wound classification system categorizes surgical procedures based on the risk of postoperative infection. Clean wounds are those with no entry into the respiratory, gastrointestinal, genitourinary, or oropharyngeal tract, whereas clean-contaminated wounds involve entry into one of these tracts under controlled conditions. Clean-contaminated wounds have a higher risk of postoperative infection compared to clean wounds.

**Why the Correct Answer is Right**
Elective open cholecystectomy for cholelithiasis involves entry into the gastrointestinal tract under controlled conditions. The surgeon typically makes a midline incision to access the gallbladder, which is a clean-contaminated procedure due to the entry into the GI tract. The presence of bile and potential for bile leakage increase the risk of postoperative infection, classifying this procedure as clean-contaminated.

**Why Each Wrong Option is Incorrect**
**Option A:** Herniorrhaphy with mesh repair is generally considered a clean wound, as it involves repairing a hernia without entering the GI tract.
**Option B:** Herniorrhaphy with mesh repair is a repeat option, and as stated, it is typically a clean wound.

**Clinical Pearl / High-Yield Fact**
Remember that the surgical wound classification system is essential in determining postoperative antibiotic prophylaxis, wound care, and postoperative surveillance. A clean-contaminated wound requires careful wound management and consideration for postoperative infection.

**Correct Answer:**
✓ Correct Answer: A. Elective open cholecystectomy for cholelithiasis