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Open retromuscular large mesh reconstruction of lumbar incisional hernias including the atrophic muscular area

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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.

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Abbreviations

LIH:

Lumbar incisional hernia

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Correspondence to Y. Renard.

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Conflict of interest

Author Renard reports grants from Meecellis, outside the submitted work. Author Palot reports personal fees from Acelity, outside the submitted work. Author de Mestier, Author Cagniet, Author Demichel, Author Marchand, Author Meffert and Author kianmanesh declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinky declaration and its later amendments or comparable ethical standards. For this retrospective study, formal consent is not required.

Human and animal rights

This article does not contain any study with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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All authors equally to this work and approved the new order of authors.

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Renard, Y., de Mestier, L., Cagniet, A. et al. Open retromuscular large mesh reconstruction of lumbar incisional hernias including the atrophic muscular area. Hernia 21, 341–349 (2017). https://doi.org/10.1007/s10029-016-1570-y

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  • DOI: https://doi.org/10.1007/s10029-016-1570-y

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