Risk factors for the development of flank hernias and bulges following surgical flank approaches to the kidney in adults

Osman, Tarek; Emam, Ahmed; Farouk, Ahmed; ElSaeed, Karim Omar; Tawfeek, Ahmed Mohamed; AbuHalima, Abdelawal

doi:10.1016/j.aju.2018.06.001

Cited by 14 publications

(22 citation statements)

References 18 publications

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“…Lower incidence of postoperative abdomen bulge or incisional hernia: In addition to the commonly recognized factors such as incision infection, old age, and high BMI, many studies have shown that the injury of muscle and neurovascular bundle (NVB) were significant risk factors for the occurrence of postoperative abdomen bulge or incisional hernia. 18,19 Some studies have also reported that increased incision length, prolonged operation time and long-term using of retractors during surgery were statistically significant factors in the development of incisional hernia. 20,21 In the present study, the incidence of postoperative abdomen bulge or incisional hernia in the CRT group was less than that in the standard group, the reasons may be related to the above factors.…”

Section: Discussionmentioning

confidence: 99%

<p>A New Surgical Technique of Combination Retroperitoneal with Transperitoneal Laparoscopic Nephroureterectomy in a Single Position and Comparative Outcomes</p>

Song¹,

Wang²,

Zhao³

et al. 2020

CMAR

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Background: The traditional surgical treatment for upper urinary tract urothelial carcinoma (UTUC) is time-consuming owing to changing the surgical position and larger surgical trauma because of open surgery in handling the distal ureter. Therefore, we created a new surgical technique of combination retroperitoneal with transperitoneal (CRT) laparoscopic nephroureterectomy (LNU) in a single position and here report our early outcomes. Methods: From January 2017 to December 2019, a total of 106 patients underwent LNU by a single surgeon at our department, of whom 50 patients underwent standard technique and 56 patients underwent CRT technique. Relevant clinical data were collected including each patient's characteristics, surgical outcomes, and follow-up results. A comparative analysis between standard LNU cases and CRT LNU cases was performed. Results: LNU was performed successfully on all 106 patients. There was no significant difference in patients' characteristics. Compared to the standard group, patients in the CRT group had shorter operative time (P=0.001), less estimated blood loss (EBL) (P<0.001), lower visual analogue scale (VAS) pain score (P=0.020) and less scarring (P=0.013). The median time of surgical drain stay decreased from 5 to 2 days (P=0.004) and median hospital stay after surgery decreased from 5 to 3 days (P=0.001). The complication rates did not show statistical differences between the two groups within the first 30 days postoperatively (P=0.263). For the long-term complications, the incidence of abdomen bulge or incisional hernia in the CRT group was less than that in the standard group (P<0.001). Conclusion: The CRT technique, which combines both the advantages of retroperitoneal and transperitoneal approaches, is a more minimally invasive, simplified and effective way to perform the LNU.

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Section: Discussionmentioning

confidence: 99%

<p>A New Surgical Technique of Combination Retroperitoneal with Transperitoneal Laparoscopic Nephroureterectomy in a Single Position and Comparative Outcomes</p>

Song¹,

Wang²,

Zhao³

et al. 2020

CMAR

View full text Add to dashboard Cite

show abstract

“…Lower incidence of postoperative abdomen bulge or incisional hernia. In addition to the commonly recognized factors such as incision infection, old age, and high BMI, many studies have shown that the injury of muscle and neurovascular bundle (NVB) were significant risk factors for the occurrence of postoperative abdomen bulge or incisional hernia [10,11]. Some studies have also reported that increased incision length, prolonged operation time and long-term using of retractors during surgery were statistically significant factors in the development of incisional hernia [12,13].…”

Section: Discussionmentioning

confidence: 99%

A New Surgical Technique of Combination Retroperitoneal with Transperitoneal Laparoscopic Nephroureterectomy in a Single Position and Comparative Outcomes

Song

Wang

Zhao

et al. 2020

Preprint

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Background The traditional surgical treatment for upper urinary tract urothelial carcinoma (UTUC) is time-consuming owing to changing the surgical position and larger surgical trauma because of open surgery in handling the distal ureter. Therefore, we created a new surgical technique of combination retroperitoneal with transperitoneal (CRT) laparoscopic nephroureterectomy (LNU) in a single position and to reported our early outcomes. Methods From January 2017 to October 2018, a total of 45 patients underwent LNU by a single surgeon at our department, of whom 25 patients underwent standard technique and 20 patients underwent CRT technique. Relevant clinical data were collected including each patient's characteristics, surgical outcomes, and follow-up results. A comparative analysis between standard LNU cases and CRT LNU cases was performed. Results LNU was performed successfully on all 45 patients. There was no significant difference in patients' characteristics.Compared to standard group, patients in CRT group had shorter operative time, less estimated blood loss (EBL), lower visual analogue scale (VAS) pain score and less scar ( P <0.001). The mean time of surgical drain stay decreased from 4.2d to 2.8d and median hospital stay after surgery decreased from 5d to 3d ( P <0.001). The complication rates did not show statistic difference between the two groups within the first 30 days postoperatively ( P =0.258). For the long-term complications, the incidence of abdomen bulge or incisional hernia in CRT group was less than that in the standard group ( P <0.001). Conclusion The CRT technique, which combines both the advantages of retroperitoneal and transperitoneal approaches, is a more minimally invasive, simplified and effective way to perform the LNU.

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“…Our current understanding of the pathogenesis of postoperative flank bulges focusses on nerve injury that leads to postoperative muscle paresis, denervation, and muscle atrophy [6,8]. Indeed, retrospective studies reported a reduced muscle volume after open partial nephrectomy, as well as a significant number of patients suffering from paraesthesia and numbness of the abdominal wall [4].…”

Section: Discussionmentioning

confidence: 99%

“…Although there is controversy relating to the precise rates of these complications, the incidence of flank bulge formation has been reported to occur in up to 57% of patients after open flank incision [4,5]. Moreover, incisional hernia following flank incision has been described in up to 17% of patients [6].…”

Section: Introductionmentioning

confidence: 99%

Single‐ vs multiple‐layer wound closure for flank incisions: results of a prospective, randomised, double‐blinded multicentre study

Kriegmair¹,

Younsi²,

Hiller³

et al. 2020

BJU International

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To compare the incidence of postoperative flank bulges between patients with multiple-layer closure and single superficiallayer closure after retroperitoneal surgery via open flank incision in the SIngle versus MUltiple-LAyer wound Closure for flank incision (SIMULAC) trial. Patients and Methods The study was a randomised controlled, patient-and assessor-blinded, multicentre trial. Between May 2015 and February 2017, 225 patients undergoing flank incisions were randomised 1:1 to a multiple-layer closure (SIMULAC-I) or a single superficial-layer closure (SIMULAC-II) group. The primary outcome was the occurrence of a flank bulge 6 months after surgery. Results Overall, 177 patients (90 in SIMULAC-I, 87 in SIMULAC-II) were eligible for final assessment. The cumulative incidence of a flank bulge was significantly higher in the SIMULAC-II group (51.7%) compared to the SIMULAC-I group [34.4%; odds ratio (OR) 2.04, 95% confidence interval (CI) 1.11-3.73; P = 0.02]. Rate of severe postoperative complications (4.4% SIMULAC-I vs 10.3% SIMULAC-II; P = 0.21) or hernia (6.7% SIMULAC-I vs 10.3% SIMULAC-II; P = 0.59) was similar between the groups. There was no difference in pain (visual analogue scale) and the requirement for pain medication at 6 months postoperatively. Quality of life assessed with the European Quality of Life 5 Dimensions Questionnaire was higher in the SIMULAC-I group compared to the SIMULAC-II group at 6 months postoperatively, with a (median range) score of 80 (30-100) vs 75 (5-100) (P = 0.012). Conclusion The overall risk of a flank bulge after flank incision is high. Multiple-layer closure after flank incision should be performed as a standard procedure.

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Risk factors for the development of flank hernias and bulges following surgical flank approaches to the kidney in adults

Cited by 14 publications

References 18 publications

<p>A New Surgical Technique of Combination Retroperitoneal with Transperitoneal Laparoscopic Nephroureterectomy in a Single Position and Comparative Outcomes</p>

<p>A New Surgical Technique of Combination Retroperitoneal with Transperitoneal Laparoscopic Nephroureterectomy in a Single Position and Comparative Outcomes</p>

A New Surgical Technique of Combination Retroperitoneal with Transperitoneal Laparoscopic Nephroureterectomy in a Single Position and Comparative Outcomes

Single‐ vs multiple‐layer wound closure for flank incisions: results of a prospective, randomised, double‐blinded multicentre study

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