of Open Lateral Abdominal Wall Hernia Repairs Patel PP DO Warren J MD Cobb WS MD Carbonell AM DO Methods A retrospective review of a prospectively maintained database was performed to identify patients ID: 911676
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A Single‐Center Experience of Open Lateral Abdominal Wall Hernia RepairsPatel PP, DO, Warren J, MD, Cobb WS, MD, Carbonell AM, DO
MethodsA retrospective review of a prospectively maintained database was performed to identify patients who underwent open repair of a lateral abdominal wall hernia between July 2006 and May 2013.Primary outcome measures were:surgical site occurrences (SSO)surgical site infections (SSI)hernia recurrence
IntroductionLateral abdominal wall hernias may occur following a variety of procedures, such asanterior spine exposureurologic proceduresostomy closurestraumaAnatomically, these hernias are challenging and require a complete understanding of abdominal wall, interparietal and retroperitoneal anatomy for successful repair. Mesh placement requires extensive dissection of often‐unfamiliar planes, and fixation is difficult. We report our experience with open mesh repair of lateral abdominal wall hernias..
Surgical TechniqueDissection to identify the hernia sacThe preperitoneal plane surrounding the hernia was developedEvery attempt was made to avoid entry into the peritoneal cavityFor subcostal hernias, there was extensive preperitoneal dissection continued under the costal margin and onto the diaphragm as necessaryThe retroperitoneum was entered laterally similar to the exposure obtained for retroperitoneal anterior spine accessInferiorly, the iliac fossa and Cooper’s ligament were exposedWide pore polypropylene mesh was used for the majority of repairsThe mesh was sized to reach the retroperitoneal space and have an overlap of at least 5cm in all directionsIf the dissection was carried inferomedially, the mesh was directly fixated to Cooper’s ligament with permanent sutureIf the defect was more inferolateral, bone anchors with permanent suture were used to secure the mesh to the iliac crestHernia defects were subsequently attempted to be closed over the mesh
Conclusion
There is little literature on lateral abdominal wall reconstruction, and the preferred method of repair of lateral defects has not been established. We describe the safety and success of lateral abdominal wall hernia repair using the sublay technique (retromuscular, interparietal, and preperitoneal planes). Our data shows low perioperative morbidity and a low recurrence rate in these difficult types of hernia repairs. Keys to a durable repair:Wide mesh overlapSecure mesh to fixed tissue/boneReconstruction of individual musculofascial layers
ResultsOverall SSO - 49.2% (primarily seroma)Overall SSI - 13.1%Mean follow up - 15.4 monthsRecurrence – 11.5% (7 patients)
defects were subsequently closed over the mesh with long‐acting absorbable suture
cranial view of dissection, showing the costal margin above, and quadratus lumborum muscle posteriorly.
visceral sac rotated medially, revealing the inferior vena cava posterio-medially
Patient who underwent open right adrenalectomy
superiorly
, the mesh was fixated to the costal margin with absorbable suture.
posteriorly
, the mesh was secured to the psoas or quadratus lumborum muscle
n=61