title: Abdominal Bulge After Retroperitoneal Dissection: The Definitive Management Using Bone Anchored Mesh.
abstract: BACKGROUND
  Abdominal bulge after retroperitoneal dissection occurs at a rate of 1% to 56%. Injury to the T11 and T12 nerves is thought to result in abdominal musculature denervation, laxity, and symptomatic abdominal bulge. This complication has become more prevalent because the retroperitoneal approach for spinal surgery has become the preferred approach in specific lumbar and thoracic cases. Current repair techniques fail to address the etiology of abdominal wall laxity, and outcomes are poorly reported. Recurrence rates in lateral abdominal bulge repair are reported between 0% and 100%, and the complication rate is nearly 25%. We present a method of bone anchored fixation of mesh for abdominal wall reinforcement after the imbrication of the atrophied musculature, resulting in the definitive treatment of abdominal bulge after retroperitoneal dissection.
  
  
  METHODS
  A retrospective review of 4 consecutive patients who underwent bony fixation of mesh using Mitek suture anchors (De Puy, Raynham, MA) for abdominal bulge after retroperitoneal dissection between February 2013 and September 2014 was performed. The preoperative, intraoperative, and postoperative records of 4 patients were reviewed and compared.
  
  
  RESULTS
  There were no reported early recurrences and no perioperative morbidity or mortality related to the operation. Average follow-up was 12.8 months (range, 6-26 months); operative time, 157 minutes; postoperative length of stay, 3.5 days; and estimated blood loss was 50 mL.
  
  
  CONCLUSIONS
  Reinforcement of the myofascial repair using bone anchored fixation of mesh represents a novel approach for the treatment of abdominal bulge after retroperitoneal dissection. Results demonstrate safety and no early recurrence.
authors.affiliation: From the *Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California; and †Center for Plastic and Reconstructive Surgery, Cedars-Sinai Medical Group, Los Angeles, CA.
authors.forename: Hyuma A
authors.initials: HA
authors.lastname: Leland
authors.forename: David A
authors.initials: DA
authors.lastname: Kulber
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000209:etiology / Q000601:surgery*; D059685:Herniorrhaphy / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery*; D012008:Recurrence; D012187:Retroperitoneal Space / Q000601:surgery*; D012189:Retrospective Studies; D013526:Surgical Mesh; D053441:Suture Anchors; D016896:Treatment Outcome