Y Renard1, L de Mestier2, A Cagniet3, N Demichel4, C Marchand4, J-L Meffert3, R Kianmanesh3, J-P Palot3. 1. Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, University of Reims Champagne-Ardenne, Rue Cognacq-Jay, 51092, Reims Cedex, France. yrenard@chu-reims.fr. 2. Department of Hepato-Gastroenterology and Digestive Oncology, Robert-Debré University Hospital, University of Reims Champagne-Ardenne, Reims, France. 3. Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, University of Reims Champagne-Ardenne, Rue Cognacq-Jay, 51092, Reims Cedex, France. 4. Department of Urology, Robert-Debré University Hospital, University of Reims Champagne-Ardenne, Reims, France.
Abstract
PURPOSE: Lumbar incisional hernias (LIH) are a rare wall defect, whose surgical management is challenging because no recommendation exists. Moreover, LIH are frequently associated with flank bulging which should be taken into account during LIH surgical repair. We aimed to describe a cohort of patients operated on for LIH using a homogeneous surgical technique and to report surgical outcomes. METHODS: The records of all consecutive patients operated on in a specialized surgical center between January 2009 and January 2015 were retrospectively reviewed. The same open technique was performed, i.e., using a mesh into the retroperitoneal space posteriorly, placed with the largest overlap inferiorly and posteriorly, and fixed through the controlateral abdominal wall muscles under strong tension to correct the flank bulging. RESULTS: The cohort included 31 patients, of median age 62, who presented two or more comorbidities in 68% of cases. LIH was recurrent in 45% of patients, and was related to nephrectomy in 61% of patients. The mesh was totally extraperitoneal in 65% of patients. The postoperative mortality rate was null. The rate of specific surgical complications was 32.3%, and the rate of overall postoperative morbidity (Clavien-Dindo classification) was 38.7%. After a median follow-up of 27.5 months, the recurrence rate was 6.5% and 9.7% reported chronic pain. CONCLUSION: The open approach for LIH repair was safe and enabled treating flank bulging simultaneously in all patients. Due to the paucity of adequate scientific studies, this reproducible open method could help moving toward a standardization of LIH surgical management.
PURPOSE: Lumbar incisional hernias (LIH) are a rare wall defect, whose surgical management is challenging because no recommendation exists. Moreover, LIH are frequently associated with flank bulging which should be taken into account during LIH surgical repair. We aimed to describe a cohort of patients operated on for LIH using a homogeneous surgical technique and to report surgical outcomes. METHODS: The records of all consecutive patients operated on in a specialized surgical center between January 2009 and January 2015 were retrospectively reviewed. The same open technique was performed, i.e., using a mesh into the retroperitoneal space posteriorly, placed with the largest overlap inferiorly and posteriorly, and fixed through the controlateral abdominal wall muscles under strong tension to correct the flank bulging. RESULTS: The cohort included 31 patients, of median age 62, who presented two or more comorbidities in 68% of cases. LIH was recurrent in 45% of patients, and was related to nephrectomy in 61% of patients. The mesh was totally extraperitoneal in 65% of patients. The postoperative mortality rate was null. The rate of specific surgical complications was 32.3%, and the rate of overall postoperative morbidity (Clavien-Dindo classification) was 38.7%. After a median follow-up of 27.5 months, the recurrence rate was 6.5% and 9.7% reported chronic pain. CONCLUSION: The open approach for LIH repair was safe and enabled treating flank bulging simultaneously in all patients. Due to the paucity of adequate scientific studies, this reproducible open method could help moving toward a standardization of LIH surgical management.
Authors: M Tobias-Machado; Freddy J Rincon; Marco T Lasmar; Joao P Zambon; Roberto V Juliano; Eric R Wroclawski Journal: Int Braz J Urol Date: 2005 Jul-Aug Impact factor: 1.541
Authors: A Moreno-Egea; J A Torralba-Martinez; G Morales; T Fernández; E Girela; J L Aguayo-Albasini Journal: Surg Endosc Date: 2004-12-02 Impact factor: 4.584
Authors: Yohann Renard; Sophie Lardière-Deguelte; Louis de Mestier; François Appere; Alban Colosio; Reza Kianmanesh; Jean-Pierre Palot Journal: Surgery Date: 2016-06-01 Impact factor: 3.982
Authors: Yohann Renard; Louis de Mestier; Julie Henriques; Paul de Boissieu; Philippe de Mestier; Abe Fingerhut; Jean-Pierre Palot; Reza Kianmanesh Journal: J Gastrointest Surg Date: 2019-01-22 Impact factor: 3.452
Authors: Joaquin M Munoz-Rodriguez; Javier Lopez-Monclus; Marina Perez-Flecha; Alvaro Robin-Valle de Lersundi; Luis A Blazquez-Hernando; Ana Royuela-Vicente; Juan P Garcia-Hernandez; Aritz Equisoain-Azcona; Manuel Medina-Pedrique; Miguel A Garcia-Urena Journal: Surg Endosc Date: 2022-06-28 Impact factor: 4.584