M Cavalli1, A Aiolfi2, A Morlacchi3, P G Bruni4, S Del Ferraro4, L Manfredini4, G Campanelli4. 1. Center of Research On the Pathology and High Specialization On the Abdominal Wall and Hernia Surgery, Milano Hernia Center, Istituto Clinico Sant'Ambrogio, Via Faravelli 16, 20147, Milano, Italy. marta_cavalli@hotmail.it. 2. General Surgery Department, Istituto Clinico Sant'Ambrogio, Via Faravelli 16, 20147, Milano, Italy. 3. Istituto Clinico Città Studi, Milano, Italy. 4. Center of Research On the Pathology and High Specialization On the Abdominal Wall and Hernia Surgery, Milano Hernia Center, Istituto Clinico Sant'Ambrogio, Via Faravelli 16, 20147, Milano, Italy.
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.
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.
Authors: R Fernández Lobato; J García Septiem; P Ortega Deballon; F J Martín Lucas; J C Ruíz de Adana; M Limones Esteban Journal: Int Surg Date: 2001 Oct-Dec
Authors: A Aiolfi; M Cavalli; A Sozzi; F Lombardo; P Mendogni; M Nosotti; G Bonitta; P G Bruni; G Campanelli; D Bona Journal: Hernia Date: 2022-05-16 Impact factor: 4.739
Authors: A Aiolfi; M Cavalli; A Sozzi; F Lombardo; A Lanzaro; V Panizzo; G Bonitta; P Mendogni; P G Bruni; G Campanelli; D Bona Journal: Hernia Date: 2021-10-30 Impact factor: 2.920
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