[Comparison of two repairing procedures for abdominal wall reconstruction in patients with flank hernia].

OBJECTIVE: To analyze the clinical therapeutic effect of extended Sublay technique via previous incision for repairing flank hernias in comparison with routine Sublay technique.
METHODS: Between May 2004 and May 2009, 41 patients with flank hernia were treated by extended Sublay repair via previous incision (extended Sublay repair group, n = 18) and by routine Sublay repair (routine Sublay repair group, n = 23). In extended Sublay repair group, there were 11 males and 7 females with an average age of 45.2 years (range, 32-61 years); flank hernia was caused by flank incision operation (12 patients with surgery history of nephrectomy, adrenalectomy, and vascular procedure) and traffic accident (6 patients) with an average disease duration of 14.5 months (range, 8-23 months); and the locations were the left flank region in 11 patients (7 affected superior lumbar triangles and 4 affected inferior lumbar triangles) and the right flank region in 7 patients (5 affected superior lumbar triangles and 2 affected inferior lumbar triangles). In routine Sublay repair group, there were 14 males and 9 females with an average age of 48.7 years (range, 33-64 years); flank hernia was caused by flank incision operation (15 patients with surgery history of nephrectomy, adrenalectomy, and vascular procedure), traffic accident (6 patients), and falling (2 patients) with an average disease duration of 18.2 months (range, 11-27 months); and the locations were the left flank region in 10 patients (5 affected superior lumbar triangles and 5 affected inferior lumbar triangles) and the right flank region in 13 patients (9 affected superior lumbar triangles and 4 affected inferior lumbar triangles). There was no significant difference in general data between 2 groups (P > 0.05).
RESULTS: The mesh size in extended Sublay repair group was significantly larger than that in routine Sublay repair group [(618.2 +/- 40.6) cm2 vs. (512.2 +/- 36.5) cm2, P < 0.05]. There was no significant difference in hernia ring size, operation time, and hospitalization day between 2 groups (P > 0.05). In extended Sublay repair group, the patients were followed up 17 to 35 months (26.2 months on average) with an early complication incidence of 27.8% (hematomas in 2 cases, seroma in 1 case, and chronic pain in 2 cases within 1 month) and a late complication incidence of 0 (no hernia recurrence and abdominal wall bulge during follow-up). In routine Sublay repair group, the patients were followed up 14-35 months (24.5 months on average) within early complication incidence of 13.0% (seroma in 1 case and chronic pains in 2 cases within 1 month) and a late complication incidence of 30.4% (hernia recurrence in 3 cases and abdominal wall bulge in 4 cases at 1-3 months). There was significant difference in the late complication incidence between 2 groups (P < 0.05).
CONCLUSION: Extended Sublay technique is a safe and effective approach for flank hernia repair. Making clear the anatomy of lumbar region, harvesting adequate space for mesh overlap, and effectively-fixing are critical to ideal clinical outcomes.