title: Retromuscular preperitoneal repair of flank hernias.
abstract: BACKGROUND
  Flank hernias represent a challenging problem to reconstructive surgeons. Their anatomic proximity to the bony prominence and major neurovascular structures limits fixation options and restricts mesh overlap. We present our technique and outcomes of a preperitoneal repair with wide mesh overlap.
  
  
  METHODS
  This study is a retrospective analysis of patients undergoing open flank hernia repair with a retromuscular preperitoneal approach.
  
  
  RESULTS
  Between September 2007 and April 2011, 16 patients, mean age 55 years (range 34-80) and BMI 33 kg/m² (range 26-46), underwent open flank hernia repair. Eight were recurrent hernias; six previously had mesh placed; nine were incarcerated. Mean hernia defect size was 232 cm² (range 25-800). Mean operative time was 178 min (range 105-245). One intraoperative complication, ureteral injury in a transplant recipient, occurred and was primarily repaired without sequela. Two patients developed wound complications, one requiring superficial debridement and another requiring partial excision (<5 %) of the mesh with secondary healing. With a mean follow-up of 16.8 months (range 2-49), no recurrent hernias were noted.
  
  
  CONCLUSIONS
  Open retromuscular preperitoneal repair of flank hernias with iliac bone fixation is technically feasible, allowing wide mesh overlap for a durable repair. This approach may offer advantages of treating abdominal wall laxity and repair of larger defects when compared to laparoscopic approaches.
authors.affiliation: Case Comprehensive Hernia Center, University Hospitals Case Medical Center, 11100 Euclid Ave, Cleveland, OH 44106, USA.
authors.forename: Melissa S
authors.initials: MS
authors.lastname: Phillips
authors.forename: David M
authors.initials: DM
authors.lastname: Krpata
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Blatnik
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Rosen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D046449:Hernia, Abdominal / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D059685:Herniorrhaphy / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010537:Peritoneum / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013526:Surgical Mesh; D016896:Treatment Outcome