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Liu Y, Huang J, Li S, Li Z, Chen C, Qu G, Chen K, Teng Y, Ma R, Ren J, Wu X. Recent Advances in Functional Hydrogel for Repair of Abdominal Wall Defects: A Review. Biomater Res 2024; 28:0031. [PMID: 38845842 PMCID: PMC11156463 DOI: 10.34133/bmr.0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 04/18/2024] [Indexed: 06/09/2024] Open
Abstract
The abdominal wall plays a crucial role in safeguarding the internal organs of the body, serving as an essential protective barrier. Defects in the abdominal wall are common due to surgery, infection, or trauma. Complex defects have limited self-healing capacity and require external intervention. Traditional treatments have drawbacks, and biomaterials have not fully achieved the desired outcomes. Hydrogel has emerged as a promising strategy that is extensively studied and applied in promoting tissue regeneration by filling or repairing damaged tissue due to its unique properties. This review summarizes the five prominent properties and advances in using hydrogels to enhance the healing and repair of abdominal wall defects: (a) good biocompatibility with host tissues that reduces adverse reactions and immune responses while supporting cell adhesion migration proliferation; (b) tunable mechanical properties matching those of the abdominal wall that adapt to normal movement deformations while reducing tissue stress, thereby influencing regulating cell behavior tissue regeneration; (c) drug carriers continuously delivering drugs and bioactive molecules to sites optimizing healing processes enhancing tissue regeneration; (d) promotion of cell interactions by simulating hydrated extracellular matrix environments, providing physical support, space, and cues for cell migration, adhesion, and proliferation; (e) easy manipulation and application in surgical procedures, allowing precise placement and close adhesion to the defective abdominal wall, providing mechanical support. Additionally, the advances of hydrogels for repairing defects in the abdominal wall are also mentioned. Finally, an overview is provided on the current obstacles and constraints faced by hydrogels, along with potential prospects in the repair of abdominal wall defects.
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Affiliation(s)
- Ye Liu
- School of Medicine,
Southeast University, Nanjing 210009, China
- Research Institute of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School,
Nanjing University, Nanjing 210002, China
| | - Jinjian Huang
- Research Institute of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School,
Nanjing University, Nanjing 210002, China
| | - Sicheng Li
- Research Institute of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School,
Nanjing University, Nanjing 210002, China
| | - Ze Li
- Research Institute of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School,
Nanjing University, Nanjing 210002, China
| | - Canwen Chen
- Research Institute of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School,
Nanjing University, Nanjing 210002, China
| | - Guiwen Qu
- School of Medicine,
Southeast University, Nanjing 210009, China
- Research Institute of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School,
Nanjing University, Nanjing 210002, China
| | - Kang Chen
- Research Institute of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School,
Nanjing University, Nanjing 210002, China
| | - Yitian Teng
- Research Institute of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School,
Nanjing University, Nanjing 210002, China
| | - Rui Ma
- School of Medicine,
Southeast University, Nanjing 210009, China
- Research Institute of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School,
Nanjing University, Nanjing 210002, China
| | - Jianan Ren
- School of Medicine,
Southeast University, Nanjing 210009, China
- Research Institute of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School,
Nanjing University, Nanjing 210002, China
| | - Xiuwen Wu
- School of Medicine,
Southeast University, Nanjing 210009, China
- Research Institute of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School,
Nanjing University, Nanjing 210002, China
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Baig SJ, Kulkarni GV, Priya P, Afaque MY, Bueno-Lledo J, Chintapatla S, de Beaux A, Gandhi JA, Urena MAG, Hammond TM, Lomanto D, Liu R, Mehta A, Miserez M, Montgomery A, Morales-Conde S, Palanivelu C, Pauli EM, Rege SA, Renard Y, Rosen M, Sanders DL, Singhal VK, Slade DAJ, Warren OJ, Wijerathne S. Delphi consensus statement for understanding and managing the subcostal hernia: subcostal hernias collaborative report (scholar study). Hernia 2024; 28:839-846. [PMID: 38366238 DOI: 10.1007/s10029-024-02963-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/05/2024] [Indexed: 02/18/2024]
Abstract
INTRODUCTION Subcostal hernias are categorized as L1 based on the European Hernia Society (EHS) classification and frequently involve M1, M2, and L2 sites. These are common after hepatopancreatic and biliary surgeries. The literature on subcostal hernias mostly comprises of retrospective reviews of small heterogenous cohorts, unsurprisingly leading to no consensus or guidelines. Given the limited literature and lack of consensus or guidelines for dealing with these hernias, we planned for a Delphi consensus to aid in decision making to repair subcostal hernias. METHODS We adopted a modified Delphi technique to establish consensus regarding the definition, characteristics, and surgical aspects of managing subcostal hernias (SCH). It was a four-phase Delphi study reflecting the widely accepted model, consisting of: 1. Creating a query. 2. Building an expert panel. 3. Executing the Delphi rounds. 4. Analysing, presenting, and reporting the Delphi results. More than 70% of agreement was defined as a consensus statement. RESULTS The 22 experts who agreed to participate in this Delphi process for Subcostal Hernias (SCH) comprised 7 UK surgeons, 6 mainland European surgeons, 4 Indians, 3 from the USA, and 2 from Southeast Asia. This Delphi study on subcostal hernias achieved consensus on the following areas-use of mesh in elective cases; the retromuscular position with strong discouragement for onlay mesh; use of macroporous medium-weight polypropylene mesh; use of the subcostal incision over midline incision if there is no previous midline incision; TAR over ACST; defect closure where MAS is used; transverse suturing over vertical suturing for closure of circular defects; and use of peritoneal flap when necessary. CONCLUSION This Delphi consensus defines subcostal hernias and gives insight into the consensus for incision, dissection plane, mesh placement, mesh type, and mesh fixation for these hernias.
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Affiliation(s)
- S J Baig
- Department of Minimal Access Surgery, Belle Vue Clinic, Digestive Surgery Clinic, Bellevue Hospital Kolkata, Kolkata, 700017, India.
| | - G V Kulkarni
- Department of Colorectal Surgery, Broomfield Hospital (Mid and South Essex NHS Trust), Essex, UK
| | - P Priya
- Department of Minimal Access Surgery, Belle Vue Clinic, Digestive Surgery Clinic, Bellevue Hospital Kolkata, Kolkata, 700017, India
| | - M Y Afaque
- Department of Surgery, J N Medical College, AMU, Aligarh, Uttar Pradesh, 202002, India
| | - J Bueno-Lledo
- Hospital Universitari I Politecnic La Fe, Universidad de Valencia, Valencia, Spain
| | - S Chintapatla
- Department of General Surgery, York Abdominal Wall Unit (YAWU), York & Scarborough Teaching Hospitals NHS Foundation Trust, Wigginton Road, York, UK
| | - A de Beaux
- Spire Murrayfield Hospital, Edinburgh, UK
| | - J A Gandhi
- Department of Surgery, King Edward Memorial Hospital, Parel, Mumbai, 400012, India
| | - M A Garcia Urena
- Department of Surgery, Hospital Universitario del Henares, 28822, Madrid, Spain
| | - T M Hammond
- Department of Colorectal Surgery, Broomfield Hospital (Mid and South Essex NHS Trust), Essex, UK
| | - D Lomanto
- Minimally Invasive Surgical Centre, National University Hospital, Singapore, 119074, Singapore
| | - R Liu
- Med Director Robotic Surgery, Alta Bates Summit Medical Center, Oakland, CA, 94609, USA
| | - A Mehta
- Department of Colorectal Surgery, St. Mark's Hospital, London, UK
| | - M Miserez
- Department of Abdominal Surgery, University Hospital Gasthuisberg, KU Leuven, Louvain, Belgium
| | - A Montgomery
- Department of Surgery, Skåne University Hospital, Malmö, Sweden
| | - S Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, Department of General and Digestive Surgery, University Hospital Virgen del Rocio, University of Sevilla, Seville, Spain
| | - C Palanivelu
- GEM Hospital and Research Centre, Coimbatore, India
| | - E M Pauli
- Division of Minimally Invasive and Bariatric Surgery, Department of Surgery, Penn State Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA
| | - S A Rege
- Department of Surgery, King Edward Memorial Hospital, Parel, Mumbai, 400012, India
| | - Y Renard
- Reims Champagne-Ardennes, Department of General, Digestive and Endocrine Surgery, Robert Debré University Hospital, Reims, France
| | - M Rosen
- Department of Surgery, Center for Abdominal Core Health, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - D L Sanders
- Department of Abdominal Wall Surgery, Royal Devon University Foundation Trust, North Devon District Hospital, Barnstaple, UK
| | - V K Singhal
- Department of GI Surgery, Medanta Medicity Hospital, Gurugram, Haryana, India
| | - D A J Slade
- Department of Colorectal Surgery, Salford Royal NHS Foundation Trust, Salford, UK
| | - O J Warren
- Department of Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - S Wijerathne
- Department of General Surgery, Alexandra Hospital, National University Health System), Singapore, Singapore
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Baig SJ, Singhal V, Afaque MY, Kakadiy C, Varma A. Peritoneal flap technique for abdominal wall expansion in the management of complex ventral hernias: a multicentre study from India. Hernia 2024; 28:863-869. [PMID: 38568349 DOI: 10.1007/s10029-024-02993-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/11/2024] [Indexed: 07/16/2024]
Abstract
INTRODUCTION Large abdominal wall hernias often require techniques for wall expansion to improve surgical outcomes. The peritoneal flap hernioplasty (PF) is one such technique that utilizes the hernia sac to reconstruct the abdominal wall, however, with limited published data. It is a modification of the Rives-Stoppa mesh repair where a part of the bisected hernia sac is utilized to reconstruct the anterior fascia and the other part for the posterior fascia. We present a collated retrospective analysis of the outcomes from three centers performing PF with or without transverse abdominis release (TAR) in patients with complex ventral hernias. METHODS The PF was performed in patients with incisional hernias, both midline and lateral. The primary outcome measured was hernia recurrence. The secondary outcomes were to evaluate pain, surgical site infection, seroma, hematoma, wound dehiscence, pseudo-recurrence, Clavien-Dindo score for complications, and the patient's reported quality of life. The quality of life was assessed by oral questionnaires in the follow-up period. RESULTS We analyzed 63 patients (38 female, 25 male) with a mean width of hernia defect of 11 cm SD 4. Based on the European Hernia Society (EHS) classification 42 patients were W3 and 21 were W2 hernias. Fifty patients had a midline hernia, while the rest of the patients included transverse, subcostal, and rooftop incision hernias. The classical peritoneal flap procedure was done in 29 (46%) patients, while the peritoneal flap with TAR was done in 34 (54%) patients. Four patients had symptomatic seroma (6%), seven superficial surgical site infection (SSI) (11%), one deep SSI (1.5%), one skin necrosis (1.5%), and one anterior peritoneal flap necrosis (1.5%). No patient required postoperative ventilatory support. The mean pain score on day one was 3/10. There was no recurrence in the mean follow-up of 17 months (range 5 to 49 months). Overall, 58 of 63 (92%) patients reported being satisfied with their surgery. CONCLUSION In our multicentre study, we found the PF technique with or without TAR for midline and non-midline ventral hernia leads to satisfactory outcomes in terms of low recurrence, low rate of complications, and a good quality of life in the medium to long term. It appears to be a useful technique in the surgeon's armamentarium to repair W2 and W3 hernias needing expansion of abdominal domain.
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Affiliation(s)
- S J Baig
- Digestive Surgery, Belle Vue Clinic, 9 and 10, Loudon Street, Kolkata, 700046, India
| | - V Singhal
- Department of GI & Bariatric Surgery, Medanta Medicity, Hospital, Gurugram, Haryana, 122001, India
| | - Md Y Afaque
- Department of Surgery, J N Medical College, AMU, Aligarh, UP, 202002, India.
| | - C Kakadiy
- DNB Gastrointestinal Surgery Resident, Medanta Medicity Hospital, Gurugram, Haryana, 122001, India
| | - A Varma
- Digestive Surgery, Belle Vue Clinic, 9 and 10, Loudon Street, Kolkata, 700046, India
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Parker SG, Blake H, Zhao S, van Dellen J, Mohamed S, Albadry W, Akhtar H, Franczak B, Jakkalasaibaba R, Rothnie A, Thomas R. An established abdominal wall multidisciplinary team improves patient care and aids surgical decision making with complex ventral hernia patients. Ann R Coll Surg Engl 2024; 106:29-35. [PMID: 36927113 PMCID: PMC10757872 DOI: 10.1308/rcsann.2022.0167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2022] [Indexed: 03/18/2023] Open
Abstract
INTRODUCTION Abdominal wall reconstruction (AWR) is an emerging subspecialty within general surgery. The practice of multidisciplinary team (MDT) meetings to aid decision making and improve patient care has been demonstrated, with widespread acceptance. This study presents our initial experience of over 150 cases of complex hernia patients discussed in a newly established MDT setting. METHODS From February 2020 to July 2022 (30-month period), abdominal wall MDTs were held bimonthly. Key stakeholders included upper and lower gastrointestinal surgeons, a gastrointestinal specialist radiologist, a plastic surgeon, a high-risk anaesthetist and two junior doctors integrated into the AWR clinical team. Meetings were held online, where patient history, past medical and surgical history, hernia characteristics and up-to-date computed tomography scans were discussed. RESULTS Some 156 patients were discussed over 18 meetings within the above period. Ninety-five (61%) patients were recommended for surgery, and 61 (39%) patients were recommended for conservative management or referred elsewhere. Seventy-eight (82%) patients were directly waitlisted, whereas seventeen (18%) required preoperative optimisation: three (18%) for smoking cessation, eleven (65%) for weight-loss management and three (18%) for specialist diabetic assessment and management. In total, 92 (59%) patients (including operative and nonoperative management) have been discharged to primary care. DISCUSSION A multidisciplinary forum for complex abdominal wall patients is a safe process that facilitates decision making, promotes education and improves patient care. As the AWR subspecialty evolves, our view is that the "complex hernia MDT" will become commonplace. We present our experience and share advice for others planning to establish an AWR centre.
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Affiliation(s)
- SG Parker
- Croydon Health Services NHS Trust, UK
| | - H Blake
- Croydon Health Services NHS Trust, UK
| | - S Zhao
- Croydon Health Services NHS Trust, UK
| | | | - S Mohamed
- Croydon Health Services NHS Trust, UK
| | - W Albadry
- St George’s University Hospitals NHS Foundation Trust, UK
| | - H Akhtar
- Croydon Health Services NHS Trust, UK
| | | | | | - A Rothnie
- Croydon Health Services NHS Trust, UK
| | - R Thomas
- Croydon Health Services NHS Trust, UK
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Khetan M, Kalhan S, John S, Sethi D, Kannaujiya P, Ramana B. MIS retromuscular repair of lateral incisional hernia: technological deliberations and short-term outcome. Hernia 2022; 26:1325-1336. [DOI: 10.1007/s10029-022-02671-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 08/30/2022] [Indexed: 11/29/2022]
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Combination of Transversus Abdominis Release and Peritoneal Flap Hernioplasty for Large Midline Ventral Hernias: A Case Series. Indian J Surg 2022. [DOI: 10.1007/s12262-021-03279-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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Köhler G, Kaltenböck R, Fehrer HJ, Függer R, Gangl O. [Management of lateral abdominal wall hernias]. Chirurg 2021; 93:373-380. [PMID: 34812906 DOI: 10.1007/s00104-021-01537-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2021] [Indexed: 11/29/2022]
Abstract
Lateral abdominal wall hernias are rare and inconsistently defined, which is why the use of the European Hernia Society classification makes sense, not least for the purpose of comparing the quality of surgical results. A distinction must be made between true fascial defects and denervation atrophy. Based on the available literature, there is generally a low level of evidence with no consensus on the best operative strategy. The proximity to bony structures and the complex anatomy of the three-layer abdominal wall make the technical treatment of lateral hernias difficult. The surgical variations include laparoendoscopic, robotic, minimally invasive, open or hybrid approaches with different mesh positions in relation to the layers of the abdominal wall. The extensive preperitoneal mesh reinforcement open, transabdominal peritoneal (TAPP) laparoscopic repair or total extraperitoneal (TEP) endoscopic repair has met with the greatest approval. The extent of the required medial mesh overlap is determined by the distance between the medial defect boundary and the lateral edge of the straight rectus abdominus muscles. The medially directed preperitoneal and retroperitoneal dissection can be extended into the homolateral retrorectus compartment by laterally incising the posterior rectus sheath or by crossing the midline behind the intact linea alba into the contralateral retrorectus compartment. The intraperitoneal onlay mesh (IPOM) technique is a suitable procedure only for smaller defects with possible defect closure but it is also important as an exit strategy in the case of a defective peritoneum. Individualized prehabilitative and preconditioning measures are just as important as the assessment of preoperative anamnestic and clinical findings and risks with radiographic cross-sectional imaging diagnostics.
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Affiliation(s)
- Gernot Köhler
- Abteilung für Allgemein und Viszeralchirurgie, Klinikum Rohrbach, Krankenhausstraße 1, 4150, Rohrbach, Österreich. .,Universitätsklinik für Chirurgie, Paracelsus Medizinische Universität Salzburg, Salzburg, Österreich.
| | - Richard Kaltenböck
- Abteilung für Allgemein, Viszeral, Gefäß, Thorax und Transplantationschirurgie, Ordensklinikum Linz, Linz, Österreich
| | - Hans-Jörg Fehrer
- Abteilung für Allgemein, Viszeral, Gefäß, Thorax und Transplantationschirurgie, Ordensklinikum Linz, Linz, Österreich.,Abteilung für Allgemein und Viszeralchirurgie, Kepler Universitätsklinikum Linz, Linz, Österreich
| | - Reinhold Függer
- Abteilung für Allgemein, Viszeral, Gefäß, Thorax und Transplantationschirurgie, Ordensklinikum Linz, Linz, Österreich.,Abteilung für Allgemein und Viszeralchirurgie, Kepler Universitätsklinikum Linz, Linz, Österreich
| | - Odo Gangl
- Abteilung für Allgemein, Viszeral, Gefäß, Thorax und Transplantationschirurgie, Ordensklinikum Linz, Linz, Österreich
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Nielsen MF, de Beaux A, Stutchfield B, Kung J, Wigmore SJ, Tulloh B. Peritoneal flap hernioplasty for repair of incisional hernias after orthotopic liver transplantation. Hernia 2021; 26:481-487. [PMID: 33884521 PMCID: PMC9012720 DOI: 10.1007/s10029-021-02409-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/07/2021] [Indexed: 12/07/2022]
Abstract
Background Repair of incisional hernias following orthotopic liver transplantation (OLT) is a surgical challenge due to concurrent midline and transverse abdominal wall defects in the context of lifelong immunosuppression. The peritoneal flap hernioplasty addresses this problem by using flaps of the hernial sac to bridge the fascial gap and isolate the mesh from both the intraperitoneal contents and the subcutaneous space, exploiting the retro-rectus space medially and the avascular plane between the internal and external oblique muscles laterally. We report our short and long-term results of 26 consecutive liver transplant cases with incisional hernias undergoing repair with the peritoneal flap technique. Methods Post-OLT patients undergoing elective peritoneal flap hernioplasty for incisional hernias from Jan 1, 2010–Nov 1, 2017 were identified from the Lothian Surgical Audit system (LSA), a prospectively-maintained computer database of all surgical procedures in the Edinburgh region of south-east Scotland. Patient demographics and clinical data were obtained from the hospital case-notes. Follow-up data were obtained in Feb 2020. Results A total of 517 liver transplantations were performed during the inclusion period. Twenty-six of these (18 males, 69%) developed an incisional hernia and underwent a peritoneal flap repair. Median mesh size (Optilene Elastic, 48 g/m2, BBraun) was 900 cm2 (range 225–1500 cm2). The median time to repair following OLT was 33 months (range 12–70 months). Median follow-up was 54 months (range 24–115 months) and median postoperative stay was 5 days (range 3–11 days). Altogether, three patients (12%) presented with postoperative complications: 1 with hematoma (4%) and two with chronic pain (8%). No episodes of infection or symptomatic seroma were recorded. No recurrence was recorded within the follow-up period. Conclusion Repair of incisional hernias in patients following liver transplantation with the Peritoneal Flap Hernioplasty is a safe procedure associated with few complications and a very low recurrence rate. We propose this technique for the reconstruction of incisional hernias following liver transplantation.
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Affiliation(s)
- M F Nielsen
- Department of Upper GI Surgery, Royal Infirmary of Edinburgh, 51 Little France Cres, Edinburgh, EH16 4SA, Scotland, UK.
- Department of Surgery, Hospital of Southern Denmark, Aabenraa, Danmark.
| | - A de Beaux
- Department of Upper GI Surgery, Royal Infirmary of Edinburgh, 51 Little France Cres, Edinburgh, EH16 4SA, Scotland, UK
| | - B Stutchfield
- Department of Upper GI Surgery, Royal Infirmary of Edinburgh, 51 Little France Cres, Edinburgh, EH16 4SA, Scotland, UK
| | - J Kung
- Department of Upper GI Surgery, Royal Infirmary of Edinburgh, 51 Little France Cres, Edinburgh, EH16 4SA, Scotland, UK
| | - S J Wigmore
- Department of Upper GI Surgery, Royal Infirmary of Edinburgh, 51 Little France Cres, Edinburgh, EH16 4SA, Scotland, UK
| | - B Tulloh
- Department of Upper GI Surgery, Royal Infirmary of Edinburgh, 51 Little France Cres, Edinburgh, EH16 4SA, Scotland, UK
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An extraperitoneal approach for complex flank, iliac, and lumbar hernia. Hernia 2020; 25:535-544. [PMID: 32451790 DOI: 10.1007/s10029-020-02214-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 05/06/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The aim of this paper is to propose our four-step technique, an open extraperitoneal approach for complex flank, lumbar, and iliac hernias. METHODS A big polypropylene mesh is placed, covering and reinforcing all the lateral abdominal wall in an extraperitoneal space. Its borders are retroxiphoid fatty triangle and the costal arch cranially and the retropubic space caudally, psoas muscle, and paravertebral region posteriorly and contralateral rectus muscle medially. Mesh dimensions do not depend from the defect size, but prosthesis has to cover all the lateral abdominal wall. RESULTS No major complications have been reported. The mean length of stay is 4.8 days (range 3-11). Mean follow-up is 44.8 months (range 5-92). One recurrence (4.5%) has been reported at the 1-year clinical evaluation. CONCLUSION In conclusion, we believe that regardless size and location of the defect, every complex lateral hernia requires the same extensive repair because of the critical anatomy of the region with a big medium-heavyweight polypropylene mesh placed in an extraperitoneal plane, the only one that allows adequate covering of the visceral sac. Our technique is a safe, feasible, and reproducible treatment for this challenging surgical problem.
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