title: Open retromuscular large mesh reconstruction of lumbar incisional hernias including the atrophic muscular area.
abstract: Lumbar incisional hernias (LIH) are a rare wall defect, whose surgical management is challenging because no recommendation exists. Moreover, LIH are frequently associated with flank bulging which should be taken into account during LIH surgical repair. We aimed to describe a cohort of patients operated on for LIH using a homogeneous surgical technique and to report surgical outcomes.
  
  
  
  The records of all consecutive patients operated on in a specialized surgical center between January 2009 and January 2015 were retrospectively reviewed. The same open technique was performed, i.e., using a mesh into the retroperitoneal space posteriorly, placed with the largest overlap inferiorly and posteriorly, and fixed through the controlateral abdominal wall muscles under strong tension to correct the flank bulging.
  
  
  
  The cohort included 31 patients, of median age 62, who presented two or more comorbidities in 68% of cases. LIH was recurrent in 45% of patients, and was related to nephrectomy in 61% of patients. The mesh was totally extraperitoneal in 65% of patients. The postoperative mortality rate was null. The rate of specific surgical complications was 32.3%, and the rate of overall postoperative morbidity (Clavien-Dindo classification) was 38.7%. After a median follow-up of 27.5 months, the recurrence rate was 6.5% and 9.7% reported chronic pain.
  
  
  
  The open approach for LIH repair was safe and enabled treating flank bulging simultaneously in all patients. Due to the paucity of adequate scientific studies, this reproducible open method could help moving toward a standardization of LIH surgical management.
authors.affiliation: Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, University of Reims Champagne-Ardenne, Rue Cognacq-Jay, 51092, Reims Cedex, France. yrenard@chu-reims.fr.
authors.forename: Y
authors.identifier: 0000-0001-6036-0006
authors.initials: Y
authors.lastname: Renard
authors.affiliation: Department of Hepato-Gastroenterology and Digestive Oncology, Robert-Debré University Hospital, University of Reims Champagne-Ardenne, Reims, France.
authors.forename: L
authors.initials: L
authors.lastname: de Mestier
authors.affiliation: Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, University of Reims Champagne-Ardenne, Rue Cognacq-Jay, 51092, Reims Cedex, France.
authors.forename: A
authors.initials: A
authors.lastname: Cagniet
authors.affiliation: Department of Urology, Robert-Debré University Hospital, University of Reims Champagne-Ardenne, Reims, France.
authors.forename: N
authors.initials: N
authors.lastname: Demichel
authors.affiliation: Department of Urology, Robert-Debré University Hospital, University of Reims Champagne-Ardenne, Reims, France.
authors.forename: C
authors.initials: C
authors.lastname: Marchand
authors.affiliation: Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, University of Reims Champagne-Ardenne, Rue Cognacq-Jay, 51092, Reims Cedex, France.
authors.forename: J-L
authors.initials: JL
authors.lastname: Meffert
authors.affiliation: Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, University of Reims Champagne-Ardenne, Rue Cognacq-Jay, 51092, Reims Cedex, France.
authors.forename: R
authors.initials: R
authors.lastname: Kianmanesh
authors.affiliation: Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, University of Reims Champagne-Ardenne, Rue Cognacq-Jay, 51092, Reims Cedex, France.
authors.forename: J-P
authors.initials: JP
authors.lastname: Palot
mesh_terms: D000009:Abdominal Muscles / Q000473:pathology / Q000601:surgery*; D034861:Abdominal Wall / Q000473:pathology / Q000601:surgery; D000368:Aged; D005260:Female; D006555:Hernia, Ventral / Q000000981:diagnostic imaging / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D000069290:Incisional Hernia / Q000000981:diagnostic imaging / Q000601:surgery*; D008161:Lumbosacral Region / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009133:Muscular Atrophy / Q000601:surgery; D019919:Prosthesis Implantation; D012189:Retrospective Studies; D013526:Surgical Mesh
keywords: Abdominal muscles; Hernia; Incisional/flank/lumbar hernia; Lumbosacral region; Operative/adverse effects; Prostheses/implants; Surgical mesh; Surgical procedures; Suture techniques; Ventral