Case Comprehensive Hernia Center, University Hospitals Case Medical Center, 11100 Euclid Ave, Cleveland, OH 44106, USA.
J Gastrointest Surg. 2012 Aug;16(8):1548-53. doi: 10.1007/s11605-012-1890-x. Epub 2012 Apr 24.
Flank hernias represent a challenging problem to reconstructive surgeons. Their anatomic proximity to the bony prominence and major neurovascular structures limits fixation options and restricts mesh overlap. We present our technique and outcomes of a preperitoneal repair with wide mesh overlap.
This study is a retrospective analysis of patients undergoing open flank hernia repair with a retromuscular preperitoneal approach.
Between September 2007 and April 2011, 16 patients, mean age 55 years (range 34-80) and BMI 33 kg/m² (range 26-46), underwent open flank hernia repair. Eight were recurrent hernias; six previously had mesh placed; nine were incarcerated. Mean hernia defect size was 232 cm² (range 25-800). Mean operative time was 178 min (range 105-245). One intraoperative complication, ureteral injury in a transplant recipient, occurred and was primarily repaired without sequela. Two patients developed wound complications, one requiring superficial debridement and another requiring partial excision (<5 %) of the mesh with secondary healing. With a mean follow-up of 16.8 months (range 2-49), no recurrent hernias were noted.
Open retromuscular preperitoneal repair of flank hernias with iliac bone fixation is technically feasible, allowing wide mesh overlap for a durable repair. This approach may offer advantages of treating abdominal wall laxity and repair of larger defects when compared to laparoscopic approaches.
侧腹部疝对重建外科医生来说是一个具有挑战性的问题。其与骨性突起和主要的神经血管结构的解剖学接近限制了固定的选择，并限制了网片的重叠。我们介绍了我们的技术以及使用大网片重叠的腹膜前修补术的结果。
这是一项对接受开放侧腹部疝修补术的患者的回顾性分析，采用了后肌膜前入路。
2007 年 9 月至 2011 年 4 月期间，16 名患者（平均年龄 55 岁，范围 34-80 岁；BMI 为 33kg/m²，范围 26-46）接受了开放侧腹部疝修补术。其中 8 例为复发性疝；6 例曾有网片放置；9 例为嵌顿性疝。平均疝缺损大小为 232cm²（范围 25-800cm²）。平均手术时间为 178 分钟（范围 105-245 分钟）。1 例术中发生输尿管损伤（移植受者），为原发性修复，无后遗症。2 例患者出现伤口并发症，1 例需要浅层清创，另 1 例需要切除（<5%）部分网片，二期愈合。平均随访 16.8 个月（范围 2-49 个月），无复发性疝。
用髂骨固定的开放式后肌膜前腹膜前修补术治疗侧腹部疝在技术上是可行的，可以进行大网片重叠，以获得持久的修复。与腹腔镜方法相比，这种方法在治疗腹壁松弛和修复较大的缺损方面可能具有优势。
