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An extraperitoneal approach for complex flank, iliac, and lumbar hernia

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Abstract

Purpose

The aim of this paper is to propose our four-step technique, an open extraperitoneal approach for complex flank, lumbar, and iliac hernias.

Methods

A big polypropylene mesh is placed, covering and reinforcing all the lateral abdominal wall in an extraperitoneal space. Its borders are retroxiphoid fatty triangle and the costal arch cranially and the retropubic space caudally, psoas muscle, and paravertebral region posteriorly and contralateral rectus muscle medially. Mesh dimensions do not depend from the defect size, but prosthesis has to cover all the lateral abdominal wall.

Results

No major complications have been reported. The mean length of stay is 4.8 days (range 3–11). Mean follow-up is 44.8 months (range 5–92). One recurrence (4.5%) has been reported at the 1-year clinical evaluation.

Conclusion

In conclusion, we believe that regardless size and location of the defect, every complex lateral hernia requires the same extensive repair because of the critical anatomy of the region with a big medium-heavyweight polypropylene mesh placed in an extraperitoneal plane, the only one that allows adequate covering of the visceral sac.

Our technique is a safe, feasible, and reproducible treatment for this challenging surgical problem.

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Authors and Affiliations

  1. Center of Research On the Pathology and High Specialization On the Abdominal Wall and Hernia Surgery, Milano Hernia Center, Istituto Clinico Sant’Ambrogio, Via Faravelli 16, 20147, Milano, Italy

    M. Cavalli, P. G. Bruni, S. Del Ferraro, L. Manfredini & G. Campanelli

  2. General Surgery Department, Istituto Clinico Sant’Ambrogio, Via Faravelli 16, 20147, Milano, Italy

    A. Aiolfi

  3. Istituto Clinico Città Studi, Milano, Italy

    A. Morlacchi

Authors
  1. M. Cavalli
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  2. A. Aiolfi
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  3. A. Morlacchi
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  4. P. G. Bruni
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  5. S. Del Ferraro
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  6. L. Manfredini
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  7. G. Campanelli
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Correspondence to M. Cavalli.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Supplementary file1 Movie1 Placement of the mesh in the extraperitoneal space. It is clear to see that laterally the mesh covers the peritoneal sheath and rests on the entire iliac wing, not just the anterior superior iliac spine. Mesh is then placed medially in the retromuscular space. At the end, fibrin glue is sprayed on the mesh surface (MP4 52660 kb)

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Cavalli, M., Aiolfi, A., Morlacchi, A. et al. An extraperitoneal approach for complex flank, iliac, and lumbar hernia. Hernia 25, 535–544 (2021). https://doi.org/10.1007/s10029-020-02214-6

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  • DOI: https://doi.org/10.1007/s10029-020-02214-6

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