pp 1–9 | Cite as

Combined open and laparoscopic approach for repair of flank hernias: technique description and medium-term outcomes of a single surgeon

  • P. H. F. AmaralEmail author
  • L. Tastaldi
  • P. H. F. Barros
  • I. P. Abreu Neto
  • B. L. Hernani
  • H. Brasil
  • C. J. L. Mendes
  • M. Y. Franciss
  • A. M. PachecoJr.
  • R. Altenfelder Silva
  • S. Roll



A residual bulge in the lateral abdominal wall is a reason for patient dissatisfaction after flank hernia repair (FHR). We hypothesized that combining a laparoscopically-placed intraperitoneal mesh (IPOM) with onlay hernia repair performed through a small open incision would increase repair durability and decrease such residual bulges. We aim to report our medium-term outcomes with this technique.


Patients who have undergone FHR using the technique described above from March 2013 through June 2017 were identified in a prospectively maintained database. Outcomes of interest included surgical site infections (SSI), surgical site occurrences (SSO), surgical site occurrences requiring procedural intervention (SSOPI) and hernia recurrence.


Sixteen patients were identified (62% females; mean age 59 ± 8 years, mean body mass index 29.5 kg/m2). Mean hernia width was. 6.4 ± 3 cm and 31% were recurrent hernias previously repaired through an onlay approach. Mean operative time was 159 ± 40 min, fascial closure was achieved in all cases, and there were no intraoperative complications. Median length of stay was 3 days (IQR 3–4), and there were no unplanned readmissions or reoperations. At a median 37-month follow-up (IQR 21–55), wound morbidity rate was 12.5% (2 seromas). There were no SSI/SSOPI and one hernia recurrence (6%) was detected at 12 months postoperatively.


Combining laparoscopic IPOM with open onlay hernia repair resulted in low recurrence and acceptable wound morbidity rates, with no residual bulges noted at medium-term follow-up. Further studies with larger number of patients and other surgeon’s experiences are necessary to determine the role of such technique in the surgical armamentarium for flank hernia repair.


Hernia Flank hernia Lumbar hernia Laparoscopic Onlay Ventral Hernia 


Compliance with ethical standards

Conflict of interest

LT received a resident research grant from the Americas Hernia Society Quality Collaborative unrelated to the present submission. MYF has received personal fees for consulting from B.Braun, Medtronic and Ethicon that are not related to the present submission. SR has received personal fees for consulting from B. Braun, Medtronic, Ethicon and Bard that are not related to the present submission.

Ethical approval

The protocol was approved by the ethics committee of the institutions.

Human and animal rights

The article does not contain any animal studies.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  • P. H. F. Amaral
    • 1
    • 2
    Email author
  • L. Tastaldi
    • 3
  • P. H. F. Barros
    • 1
    • 2
  • I. P. Abreu Neto
    • 1
    • 2
  • B. L. Hernani
    • 1
    • 2
  • H. Brasil
    • 2
  • C. J. L. Mendes
    • 2
  • M. Y. Franciss
    • 2
  • A. M. PachecoJr.
    • 2
  • R. Altenfelder Silva
    • 2
  • S. Roll
    • 1
    • 2
  1. 1.Hernia CenterHospital Alemão Oswaldo CruzSão PauloBrazil
  2. 2.Abdominal Wall Surgery Group, Department of SurgeryIrmandade da Santa Casa de Misericórdia de São PauloSão PauloBrazil
  3. 3.Comprehensive Hernia Center, Digestive Disease and Surgery InstituteThe Cleveland Clinic FoundationClevelandUSA

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