title: Flank hernia and bulging after open nephrectomy: mesh repair by flank or median approach? Report of a novel technique.
abstract: Flank incisions may be associated with flank hernias, which may be complicated with incarceration and strangulation. Furthermore, they may cause a significant limitation of the patient's quality of life. In the period 1997-2006 we performed 15 flank hernia repairs with a prosthetic mesh implantation. From 1997 to 2001 hernias were managed with a standardized mesh implantation through the initial flank incision (seven cases, flank group). Since 2001 we have adopted a novel operative approach in eight patients. Through a median laparotomy and following a transabdominally reduction of the hernia sac, a prosthetic polypropylene mesh [Prolene, Vypro or UltraPro, Ethicon Endo-Surgery (Europe) GmbH, Norderstedt, Germany] overlapping the midline was placed in a sublay technique (median group). The perioperative complication rate was comparable and they consisted mostly of postoperative seromas. A patient from the flank group developed a hernia recurrence two months after surgery. Thirteen patients participated in the annual follow-up for a total follow-up time of five years. In this period we observed only one additional case of hernia recurrence: a patient of the flank group presented with a 3 cm hernia recurrence at the proximal end of the previous operative incision. No recurrence was observed in the median group. As a result the novel technique for open repair of flank incisional hernias we present permits a remodelling of the abdominal wall and is associated with excellent postoperative results.
authors.affiliation: Department of General, Visceral, Vascular and Thoracic Surgery, Charité, Campus Mitte, Humboldt University of Berlin, Charitéplatz 1, 10117, Berlin, Germany. juergen.zieren@charite.de
authors.forename: Jürgen
authors.initials: J
authors.lastname: Zieren
authors.forename: Charalambos
authors.initials: C
authors.lastname: Menenakos
authors.forename: Kasra
authors.initials: K
authors.lastname: Taymoorian
authors.forename: Jochen M
authors.initials: JM
authors.lastname: Müller
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects*; D011126:Polypropylenes; D011446:Prospective Studies; D012008:Recurrence; D013526:Surgical Mesh; D016896:Treatment Outcome
chemical_list: D011126:Polypropylenes