Renard Y, de Mestier L, Cagniet A, Demichel N, Marchand C, Meffert J-L, Kianmanesh R, Palot J-P
Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, University of Reims Champagne-Ardenne, Rue Cognacq-Jay, 51092, Reims Cedex, France.
Department of Hepato-Gastroenterology and Digestive Oncology, Robert-Debré University Hospital, University of Reims Champagne-Ardenne, Reims, France.
Hernia. 2017 Jun;21(3):341-349. doi: 10.1007/s10029-016-1570-y. Epub 2017 Jan 17.
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.
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.
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.
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.
腰椎切口疝（LIH）是一种罕见的腹壁缺损，由于缺乏相关推荐，其手术治疗具有挑战性。此外，LIH常伴有侧腹膨出，在LIH手术修复时应予以考虑。我们旨在描述一组采用同种手术技术进行LIH手术的患者，并报告手术结果。
回顾性分析2009年1月至2015年1月在一家专业外科中心接受手术的所有连续患者的病历。采用相同的开放技术，即向后将补片置入腹膜后间隙，补片最大重叠部分置于下方和后方，并在强张力下通过对侧腹壁肌肉固定以纠正侧腹膨出。
该队列包括31例患者，中位年龄62岁，68%的病例存在两种或更多合并症。45%的患者LIH复发，61%的患者LIH与肾切除术有关。65%的患者补片完全位于腹膜外。术后死亡率为零。特异性手术并发症发生率为32.3% , 术后总体发病率（Clavien-Dindo分类）为38.7%。中位随访27.5个月后，复发率为6.5%，9.7%的患者报告有慢性疼痛。
LIH修复的开放手术方法安全，且能同时治疗所有患者的侧腹膨出。由于缺乏充分的科学研究，这种可重复的开放方法可能有助于推动LIH手术治疗的标准化。
