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Updated: Dec 20, 2025
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Surgical Approach and Complications of Stand-alone Lateral Trans-Psoas Interbody Fusion
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An extraperitoneal approach for complex flank, iliac, and lumbar hernia
M Cavalli1, A Aiolfi2, A Morlacchi3
1Center of Research On the Pathology and High Specialization On the Abdominal Wall and Hernia Surgery, Milano Hernia Center, Istituto Clinico Sant'Ambrogio, Via Faravelli 16, 20147, Milano, Italy. marta_cavalli@hotmail.it.
Summary
This study introduces a four-step open extraperitoneal approach for complex flank, lumbar, and iliac hernias. The technique uses a large polypropylene mesh for extensive abdominal wall repair, proving safe and effective.
Area of Science:
- Surgical innovation in abdominal wall reconstruction.
- Hernia repair techniques.
Background:
- Complex flank, lumbar, and iliac hernias present significant surgical challenges.
- Current repair methods may have limitations in achieving adequate coverage.
Purpose of the Study:
- To propose and evaluate a novel four-step open extraperitoneal approach for complex lateral hernias.
- To demonstrate the efficacy of a standardized mesh placement strategy.
Main Methods:
- Utilizing an open extraperitoneal approach for hernia repair.
- Placing a large polypropylene mesh to cover the entire lateral abdominal wall in the extraperitoneal space.
- Defining specific anatomical borders for mesh placement.
Main Results:
- No major complications were reported in the study cohort.
- The mean length of hospital stay was 4.8 days.
- A low recurrence rate of 4.5% was observed at a mean follow-up of 44.8 months.
Conclusions:
- The proposed four-step technique is a safe, feasible, and reproducible method for complex lateral hernias.
- Extensive repair with a large mesh in the extraperitoneal plane is recommended regardless of defect size.
- This approach ensures adequate coverage of the visceral sac in challenging hernia cases.
