Retromuscular Preperitoneal Repair of Flank Hernias
Flank hernias represent a challenging problem to reconstructive surgeons. Their anatomic proximity to the bony prominence and major neurovascular structures limits fixation options and restricts mesh overlap. We present our technique and outcomes of a preperitoneal repair with wide mesh overlap.
This study is a retrospective analysis of patients undergoing open flank hernia repair with a retromuscular preperitoneal approach.
Between September 2007 and April 2011, 16 patients, mean age 55 years (range 34–80) and BMI 33 kg/m2 (range 26–46), underwent open flank hernia repair. Eight were recurrent hernias; six previously had mesh placed; nine were incarcerated. Mean hernia defect size was 232 cm2 (range 25–800). Mean operative time was 178 min (range 105–245). One intraoperative complication, ureteral injury in a transplant recipient, occurred and was primarily repaired without sequela. Two patients developed wound complications, one requiring superficial debridement and another requiring partial excision (<5 %) of the mesh with secondary healing. With a mean follow-up of 16.8 months (range 2–49), no recurrent hernias were noted.
Open retromuscular preperitoneal repair of flank hernias with iliac bone fixation is technically feasible, allowing wide mesh overlap for a durable repair. This approach may offer advantages of treating abdominal wall laxity and repair of larger defects when compared to laparoscopic approaches.
KeywordsFlank hernia Lumbar hernia Hernia repair Bone fixation Retromuscular repair
Michael Rosen discloses being a speaker for Lifecell with research support from Lifecell, Davol, W.L. Gore, and Cook.
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