Abstract
Purpose
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.
Methods
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.
Results
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.
Conclusion
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.







Similar content being viewed by others
Abbreviations
- LIH:
-
Lumbar incisional hernia
References
Muysoms FE, Miserez M, Berrevoet F, Campanelli G, Champault GG, Chelala E, Dietz UA, Eker HH, El Nakadi I, Hauters P, Hidalgo Pascual M, Hoeferlin A, Klinge U, Montgomery A, Simmermacher RKJ, Simons MP, Smietański M, Sommeling C, Tollens T, Vierendeels T, Kingsnorth A (2009) Classification of primary and incisional abdominal wall hernias. Hernia 13:407–414
Moreno-Egea A (2007) Controversies in the current management of lumbar hernias. Arch Surg 142:82
Shekarriz B, Graziottin TM, Gholami S, Lu H-F, Yamada H, Duh Q-Y, Stoller ML (2001) Transperitoneal preperitoneal laparoscopic lumbar incisional herniorrhaphy. J Urol 166:1267–1269
Palanivelu C, Rangarajan M, John SJ, Madankumar MV, Senthilkumar K (2008) Laparoscopic transperitoneal repair of lumbar incisional hernias: a combined suture and “double-mesh” technique. Hernia 12:27–31
Soto Delgado M, García Ureña MA, Velasco García M, Pedrero Márquez G (2002) Lumbar eventration as complication of the lumbotomy in the flank: review of our series. Actas Urol Esp 26:345–350
Honig MP, Mason RA, Giron F (1992) Wound complications of the retroperitoneal approach to the aorta and iliac vessels. J Vasc Surg 15:28–33 (discussion 33–34)
Do MV, Richardson WS (2012) Lumbar incisional hernia repair after iliac crest bone graft. Ochsner J 12:80–81
Ward JN, Lavengood RW, Subramaniam AP, Draper JW (1974) Lumbar approaches to kidney: complications associated with procedure. Urology 3:163–167
Salameh JR, Salloum EJ (2004) Lumbar incisional hernias: diagnostic and management dilemma. JSLS 8:391–394
Ventral Hernia Working Group, Breuing K, Butler CE, Ferzoco S, Franz M, Hultman CS, Kilbridge JF, Rosen M, Silverman RP, Vargo D (2010) Incisional ventral hernias: review of the literature and recommendations regarding the grading and technique of repair. Surgery 148:544–558
Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213
Bouhassira D, Attal N, Fermanian J, Alchaar H, Gautron M, Masquelier E, Rostaing S, Lanteri-Minet M, Collin E, Grisart J, Boureau F (2004) Development and validation of the neuropathic pain symptom inventory. Pain 108:248–257
Attal N, Fermanian C, Fermanian J, Lanteri-Minet M, Alchaar H, Bouhassira D (2008) Neuropathic pain: are there distinct subtypes depending on the aetiology or anatomical lesion? Pain 138:343–353
Bennett MI, Attal N, Backonja MM, Baron R, Bouhassira D, Freynhagen R, Scholz J, Tölle TR, Wittchen H-U, Jensen TS (2007) Using screening tools to identify neuropathic pain. Pain 127:199–203
Lichtenstein IL (1986) Repair of large diffuse lumbar hernias by an extraperitoneal binder technique. Am J Surg 151:501–504
Renard Y, Lardière-Deguelte S, de Mestier L, Appere F, Colosio A, Kianmanesh R, Palot J-P (2016) Management of large incisional hernias with loss of domain: a prospective series of patients prepared by progressive preoperative pneumoperitoneum. Surgery 160:426–435
Lal R, Sharma D, Hazrah P, Kumar P, Borgharia S, Agarwal A (2014) Laparoscopic management of nonmidline ventral hernia. J Laparoendosc Adv Surg Tech A 24:445–450
Yavuz N, Ersoy YE, Demirkesen O, Tortum OB, Erguney S (2009) Laparoscopic incisional lumbar hernia repair. Hernia 13:281–286
Veyrie N, Poghosyan T, Corigliano N, Canard G, Servajean S, Bouillot J-L (2013) Lateral incisional hernia repair by the retromuscular approach with polyester standard mesh: topographic considerations and long-term follow-up of 61 consecutive patients. World J Surg 37:538–544
Stumpf M, Conze J, Prescher A, Junge K, Krones CJ, Klinge U, Schumpelick V (2009) The lateral incisional hernia: anatomical considerations for a standardized retromuscular sublay repair. Hernia 13:293–297
Bolkier M, Moskovitz B, Ginesin Y, Levin DR (1991) An operation for incisional lumbar hernia. Eur Urol 20:52–53
Patten LC, Awad SS, Berger DH, Fagan SP (2004) A novel technique for the repair of lumbar hernias after iliac crest bone harvest. Am J Surg 188:85–88
Carbonell AM, Kercher KW, Sigmon L, Matthews BD, Sing RF, Kneisl JS, Heniford BT (2005) A novel technique of lumbar hernia repair using bone anchor fixation. Hernia 9:22–25
Stamatiou D, Skandalakis JE, Skandalakis LJ, Mirilas P (2009) Lumbar hernia: surgical anatomy, embryology, and technique of repair. Am Surg 75:202–207
Cavallaro G, Sadighi A, Paparelli C, Miceli M, D’Ermo G, Polistena A, Cavallaro A, De Toma G (2009) Anatomical and surgical considerations on lumbar hernias. Am Surg 75:1238–1241
Gardner GP, Josephs LG, Rosca M, Rich J, Woodson J, Menzoian JO (1994) The retroperitoneal incision. An evaluation of postoperative flank “bulge”. Arch Surg 129:753–756
Staerman F, Staerman H, Guiraud P, Mhidia A, Guille F, Lobel B (1997) Autogenous skin graft in the treatment of large incisional lumbar hernias and bulges. Eur Urol 32:209–212
Crouzet S, Chopra S, Tsai S, Kamoi K, Haber G-P, Remer EM, Berger AK, Gill IS, Aron M (2014) Flank muscle volume changes after open and laparoscopic partial nephrectomy. J Endourol 28:1202–1207
Woodward AM, Flint LM, Ferrara JJ (1999) Laparoscopic retroperitoneal repair of recurrent postoperative lumbar hernia. J Laparoendosc Adv Surg Tech A 9:181–186
Arca MJ, Heniford BT, Pokorny R, Wilson MA, Mayes J, Gagner M (1998) Laparoscopic repair of lumbar hernias. J Am Coll Surg 187:147–152
Tobias-Machado M, Rincon FJ, Lasmar MT, Zambon JP, Juliano RV, Wroclawski ER (2005) Laparoscopic surgery for treatment of incisional lumbar hernia. Int Braz J Urol 31:309–314
Moreno-Egea A, Carrillo-Alcaraz A (2012) Management of non-midline incisional hernia by the laparoscopic approach: results of a long-term follow-up prospective study. Surg Endosc 26:1069–1078
Moreno-Egea A, Torralba-Martinez JA, Morales G, Fernández T, Girela E, Aguayo-Albasini JL (2005) Open vs laparoscopic repair of secondary lumbar hernias: a prospective nonrandomized study. Surg Endosc 19:184–187
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
Author Renard reports grants from Meecellis, outside the submitted work. Author Palot reports personal fees from Acelity, outside the submitted work. Author de Mestier, Author Cagniet, Author Demichel, Author Marchand, Author Meffert and Author kianmanesh declare that they have no conflict of interest.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinky declaration and its later amendments or comparable ethical standards. For this retrospective study, formal consent is not required.
Human and animal rights
This article does not contain any study with animals performed by any of the authors.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Additional information
All authors equally to this work and approved the new order of authors.
Rights and permissions
About this article
Cite this article
Renard, Y., de Mestier, L., Cagniet, A. et al. Open retromuscular large mesh reconstruction of lumbar incisional hernias including the atrophic muscular area. Hernia 21, 341–349 (2017). https://doi.org/10.1007/s10029-016-1570-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10029-016-1570-y