An evidence-based model for the successful treatment of flank and lateral abdominal wall hernias

Ronnie A. Pezeshk, Benson J. Pulikkottil, Steven H. Bailey, Nathaniel E. Schaffer, Edward M. Reece, Nicholas J. Thornton, Alexander R. Gupta, Ronald E. Hoxworth

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background: Lateral abdominal wall defects are a significant contributor to patient morbidity and mortality in the United States. Reconstruction involving flank hernias and bulges is relatively scarce in the literature despite its serious consequences. The authors aim to identify an objective approach for the evaluation and successful repair of defects of the lateral abdominal wall. Methods: A retrospective analysis was carried out on patients presenting for open repair of a lateral wall defect performed by a single surgeon. Over a 5-year period, there were 29 consecutive patients with a mean follow-up period of 21.2 months. Patient demographics including body mass index, number of hernia defects, number of previous repairs/abdominal operations, defect size, operative time, blood loss, and complications (e.g., recurrence/bulge, seroma, hematoma, wound infection, persistent pain, skin breakdown, and fascial dehiscence) were collected. Results: Patients who underwent flank hernia repairs using an inlay/underlay nonbridged technique with the use of acellular dermal matrix had low recurrence and overall complication rates. Only one patient (3.4 percent) had a recurrence at follow-up, and another patient (3.4 percent) had developed a bulge. Conclusions: The authors' data indicate successful results when their technique is applied. Proper patient selection is essential, along with a thorough understanding of anatomy and techniques for successful reconstruction. The authors recommend using an inlay (preferred) or underlay repair with acellular dermal matrix to reinforce the surrounding musculofascial closure. This technique, in conjunction with the authors' holistic abdominal wall reconstruction protocol, has optimized outcomes and identified a successful multidisciplinary strategy for the reconstruction of lateral wall defects.

Original languageEnglish (US)
Pages (from-to)377-385
Number of pages9
JournalPlastic and Reconstructive Surgery
Volume136
Issue number2
DOIs
StatePublished - Aug 31 2015

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Abdominal Hernia
Abdominal Wall
Acellular Dermis
Inlays
Hernia
Recurrence
Therapeutics
Seroma
Herniorrhaphy
Wound Infection
Operative Time
Hematoma
Patient Selection
Anatomy
Body Mass Index
Demography
Morbidity
Pain
Skin
Mortality

ASJC Scopus subject areas

  • Surgery

Cite this

An evidence-based model for the successful treatment of flank and lateral abdominal wall hernias. / Pezeshk, Ronnie A.; Pulikkottil, Benson J.; Bailey, Steven H.; Schaffer, Nathaniel E.; Reece, Edward M.; Thornton, Nicholas J.; Gupta, Alexander R.; Hoxworth, Ronald E.

In: Plastic and Reconstructive Surgery, Vol. 136, No. 2, 31.08.2015, p. 377-385.

Research output: Contribution to journalArticle

Pezeshk, RA, Pulikkottil, BJ, Bailey, SH, Schaffer, NE, Reece, EM, Thornton, NJ, Gupta, AR & Hoxworth, RE 2015, 'An evidence-based model for the successful treatment of flank and lateral abdominal wall hernias', Plastic and Reconstructive Surgery, vol. 136, no. 2, pp. 377-385. https://doi.org/10.1097/PRS.0000000000001432
Pezeshk, Ronnie A. ; Pulikkottil, Benson J. ; Bailey, Steven H. ; Schaffer, Nathaniel E. ; Reece, Edward M. ; Thornton, Nicholas J. ; Gupta, Alexander R. ; Hoxworth, Ronald E. / An evidence-based model for the successful treatment of flank and lateral abdominal wall hernias. In: Plastic and Reconstructive Surgery. 2015 ; Vol. 136, No. 2. pp. 377-385.
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AU - Reece, Edward M.

AU - Thornton, Nicholas J.

AU - Gupta, Alexander R.

AU - Hoxworth, Ronald E.

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N2 - Background: Lateral abdominal wall defects are a significant contributor to patient morbidity and mortality in the United States. Reconstruction involving flank hernias and bulges is relatively scarce in the literature despite its serious consequences. The authors aim to identify an objective approach for the evaluation and successful repair of defects of the lateral abdominal wall. Methods: A retrospective analysis was carried out on patients presenting for open repair of a lateral wall defect performed by a single surgeon. Over a 5-year period, there were 29 consecutive patients with a mean follow-up period of 21.2 months. Patient demographics including body mass index, number of hernia defects, number of previous repairs/abdominal operations, defect size, operative time, blood loss, and complications (e.g., recurrence/bulge, seroma, hematoma, wound infection, persistent pain, skin breakdown, and fascial dehiscence) were collected. Results: Patients who underwent flank hernia repairs using an inlay/underlay nonbridged technique with the use of acellular dermal matrix had low recurrence and overall complication rates. Only one patient (3.4 percent) had a recurrence at follow-up, and another patient (3.4 percent) had developed a bulge. Conclusions: The authors' data indicate successful results when their technique is applied. Proper patient selection is essential, along with a thorough understanding of anatomy and techniques for successful reconstruction. The authors recommend using an inlay (preferred) or underlay repair with acellular dermal matrix to reinforce the surrounding musculofascial closure. This technique, in conjunction with the authors' holistic abdominal wall reconstruction protocol, has optimized outcomes and identified a successful multidisciplinary strategy for the reconstruction of lateral wall defects.

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