Purnell Chad A, Park Eugene, Turin Sergey Y, Dumanian Gregory A
Chicago, Ill. From the Division of Plastic Surgery, Northwestern University Feinberg School of Medicine.
Plast Reconstr Surg. 2016 Mar;137(3):994-1001. doi: 10.1097/01.prs.0000479987.80490.5c.
Although there is a high incidence of flank defects after lateral abdominal access, there is a paucity of large studies discussing this problem. Most studies express nihilism regarding their surgical management. The goal of this study was to describe the authors' conceptualization of flank defects, with a determination of the number of true hernias versus bulges, and outcomes of surgical repair in these patients.
The authors carried out a 13-year retrospective review of 31 consecutive flank defects repaired by the senior author (G.A.D.). Patients were treated with a 7.5-cm-wide macroporous polypropylene mesh and reapproximation of the abdominal wall to achieve a direct supported repair. There were 19 intraperitoneal placements and 12 placements between the external and internal oblique muscles or preperitoneal space. The prevalence of true hernia versus bulge at the time of repair was noted.
There were no surgical-site infections. Two patients developed minor bulges at the prior hernia site: one of these was repaired with additional mesh, and the other one was observed. One small asymptomatic recurrent hernia was noted incidentally on a follow-up computed tomographic scan. Initially, 10 patients had a complete hernia through all layers of the lateral abdominal musculature, 17 patients had dehiscence of the internal oblique and transversus abdominis muscles with an intact external oblique muscle, and four patients had denervation with all layers of the abdominal wall intact.
Most flank defects represent true hernias rather than denervation injuries. Direct supported repair of flank hernias using mesh is a safe and effective technique.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
尽管经侧腹部入路后胁腹缺损的发生率很高，但缺乏关于这一问题的大型研究。大多数研究对其手术治疗持消极态度。本研究的目的是描述作者对胁腹缺损的概念化认识，确定真性疝与膨出的数量，以及这些患者手术修复的结果。
作者对资深作者（G.A.D.）连续修复的31例胁腹缺损进行了为期13年的回顾性研究。患者采用7.5厘米宽的大孔聚丙烯网片治疗，并重新缝合腹壁以实现直接支撑修复。有19例置于腹腔内，12例置于腹外斜肌与腹内斜肌之间或腹膜前间隙。记录修复时真性疝与膨出的发生率。
无手术部位感染。两名患者在原疝部位出现轻微膨出：其中一名用额外的网片修复，另一名进行观察。在随访计算机断层扫描中偶然发现1例小的无症状复发性疝。最初，10例患者通过侧腹部肌肉的所有层次出现完全性疝，17例患者腹内斜肌和腹横肌裂开，腹外斜肌完整，4例患者神经支配丧失，腹壁各层完整。
大多数胁腹缺损为真性疝而非神经损伤。使用网片对胁腹疝进行直接支撑修复是一种安全有效的技术。
临床问题/证据水平：治疗性，IV级。
