Postoperative Flank Defects, Hernias, and Bulges: A Reliable Method for Repair

Area of Science:

• General Surgery
• Abdominal Wall Reconstruction
• Hernia Repair

Background:

• Flank defects are common after lateral abdominal access but lack extensive study.
• Surgical management of these defects is often approached with nihilism.
• This study aims to clarify the nature of flank defects and evaluate repair outcomes.

Purpose of the Study:

• To conceptualize flank defects and differentiate true hernias from bulges.
• To determine the outcomes of surgical repair for flank defects.
• To evaluate the efficacy of direct supported repair with mesh.

Main Methods:

• Retrospective review of 31 flank defects over 13 years.
• Repair using a 7.5-cm macroporous polypropylene mesh with direct abdominal wall reapproximation.
• Mesh placement included intraperitoneal and between muscle layers/preperitoneal space.

Main Results:

• No surgical-site infections were reported.
• Two minor bulges and one small asymptomatic recurrent hernia were observed.
• Defect types included complete hernias, muscle dehiscence, and denervation injuries.

Conclusions:

• Flank defects are predominantly true hernias, not solely denervation injuries.
• Direct supported repair of flank hernias with mesh is a safe and effective surgical technique.