An Evidence-Based Model for the Successful Treatment of Flank and Lateral Abdominal Wall Hernias

Pezeshk, Ronnie A.; Pulikkottil, Benson J.; Bailey, Steven H.; Schaffer, Nathaniel E.; Reece, Edward M.; Thornton, Nicholas; Gupta, Alexander R; Hoxworth, Ronald E.

doi:10.1097/prs.0000000000001432

Cited by 25 publications

(35 citation statements)

References 7 publications

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“…Prior published reports of lumbodorsal hernias after open retroperitoneal procedures identified patient risk factors including elevated BMI, tobacco use, DM, HTN, COPD, CAD, and end-stage renal disease. [14][15][16][17][18][19] Specifically, a BMI of >23 mg/kg has been strongly associated with development of fascial hernias ( p = 0.018, odds ratio = 16.9). 20 Similar elevated risk ratios were seen in BMI >26 and >28 in separate studies.…”

Section: Discussionmentioning

confidence: 99%

Incisional Lumbodorsal Hernias Following Retroperitoneal Robotic Partial Nephrectomies for Small Renal Masses at a High-Volume Tertiary Referral Center

Chow

Wahba

Phillips

et al. 2021

Journal of Endourology

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Introduction: Herein we evaluate the incidence of incisional lumbodorsal hernia (ILDH) after retroperitoneal robotic partial nephrectomy (RRPN) and associated patient-specific and tumor-specific risk factors. Furthermore, we aim to evaluate the role of routine lumbodorsal fascial closure for the prevention of ILDH. Methodology: This is a retrospective review of our robotic partial nephrectomy database of all RRPNs performed at Washington University School of Medicine from 2000 to 2020. Postoperative imaging was reviewed for evidence of ILDH. A clinically significant hernia was defined as the protrusion of visceral organ(s) through the lumbodorsal fascia. Patient and tumor characteristics, and fascial closure techniques were analyzed to determine predictors of ILDH. Results: In total, 150 patients underwent RRPN between 2007 and 2020 with an average follow-up of 4.9 (1-37) months. Twelve (8%) ILDHs were identified. Ten (6.7%) patients had herniated retroperitoneal fat whereas 2 (1.3%) patients had herniated colon. All were asymptomatic and managed conservatively. On matched cohort comparison, patients with ILDH had larger tumors than patients without an incisional hernia (3.9 cm vs 2.8 cm, p = 0.029). In general, patient factors were no different between patients with and without ILDH. However, coronary artery disease (CAD) was more prevalent in patients with ILDH (33.3% vs 10.9%, p = 0.028). Patients with ILDH were more likely to have a port site extended for specimen extraction (66.7% vs 38.2%, p = 0.069). Lumbodorsal fascial closure and type of suture material were not associated with prevention of ILDH ( p = 0.545, p = 0.637). Conclusion:The radiographic incidence of lumbar incisional hernias after RRPN without routine fascial closure of the extraction incision was 8%. All were asymptomatic and did not require surgical repair. Larger tumor size and CAD were associated with ILDH.

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Section: Discussionmentioning

confidence: 99%

Incisional Lumbodorsal Hernias Following Retroperitoneal Robotic Partial Nephrectomies for Small Renal Masses at a High-Volume Tertiary Referral Center

Chow

Wahba

Phillips

et al. 2021

Journal of Endourology

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“…In addition, due to the rarity of such surgical condition, no standardized technique can be suggested. Several approaches have been described in the literature and, in the minimally invasive era, the laparoscopic repair with mesh placement whether intraperitoneal or preperitoneal seems to represent a valid treatment option [2,9,10,[16][17][18][19][20][21].…”

Section: Discussionmentioning

confidence: 99%

Robotic assisted treatment of flank hernias: case series

et al. 2020

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Background: Flank hernias are uncommon, surgical treatment is challenging and the minimally-invasive approach not always feasible. The aim of this study was to report the safety and feasibility of the robotic-assisted repair. Methods: The study was approved by the local ethic committee (2019-01132 CE3495). A retrospective search on a prospectively collected dataset including demographic and clinical records on robotic surgery at our institution was performed to identify patients treated for a flank hernia. Patients were followed-up 6 months. Results: From January 2018 to December 2019, out of 190 patients who underwent robotic-assisted hernia surgery, seven with incisional flank hernia were included. Median age was 69.0 years (IQR 63.2-78.0), BMI was 27.3 kg/m 2 (IQR 25.8-32.3) and two patients were male (29%). All patients were referred to surgery because of pain, whereas one of them described recurrent episodes of small bowel obstruction. The median hernia defect measured 25 mm ((IQR 21-40), median mesh diameter was 10 cm (IQR 10-12.5) and median operative time was 137 min (IQR 133-174). No intraoperative complication occurred. Postoperatively, one patient developed a pneumonia, which required antibiotics. Length of hospital stay was 4.0 days (IQR 3.0-7.7). Six months after surgery, neither recurrence nor chronic pain were recorded. Conclusions: Robotics in abdominal wall hernia surgery remains a matter of debate, despite a growing interest from the surgical community. In our reported experience with flank hernias, we found the robotic-assisted approach to be safe and feasible for the treatment of this uncommon clinical entity.

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“…A recent retrospective analysis of the treatment of flank and lateral abdominal wall hernias advocates creating musculofascial flaps and performing a primary nonbridged mesh repair to recreate anatomical congruity. 5 Another prospective review of kidney transplant recipients with flank hernias described a large posterior component separation with transverse abdominis muscle release with mesh placement in the retromuscular plane in a sublay fashion. 6 Both groups reported decreased recurrence rates 3.4 and 9%, respectively, compared to the 11.4% reported by Sauerland et al 7 in their comparison of open to laparoscopic repair of primary ventral hernias.…”

Section: Discussionmentioning

confidence: 99%