Not Just an Aside: A Retrospective Review of Flank Hernia Repair Outcomes 

SDCC 

Introduction: Defined in 2009 by the European Hernia Society, flank hernias are a subclass of lateral abdominal wall hernia. Surgery involving the spine, aorta/IVC, retroperitoneum, and organ transplantation can lead to weakening of the lateral abdominal wall and subsequent herniation. Despite the reference to a seemingly generic anatomic location, flank hernias represent a specific subset of hernias that are lateral to the rectus and within three centimeters of the umbilicus, distinct from lumbar, iliac and subcostal defects. Less commonly reported than incisional/midline hernia, outcomes are poorly defined and there exists no consensus abdominal wall closure technique. Herein, we examine flank hernia repair and patient outcomes.

Methods: A retrospective review of all ventral hernia repairs between October 2013– August 2022 performed by the senior authors was conducted. Operative reports were used to identify flank hernias. All other ventral hernias were excluded. Demographic, comorbidity, perioperative, and surgical outcome-related information was collected.  

Results: A total of 39 flank hernias (19 male, 20 female) were included in this study. The average age was 60 years [26 years, 83 years] and average BMI was 31.3. Roughly 33% of the cohort were former smokers (having quit within 30 days), and most patients (56.8%) were classified as ventral hernia wound group (VHWG) 2. Patients had a mean 2.2 prior abdominal surgeries and 0.79 prior hernia repairs. One patient had prior mesh infection, and four had prior wound infections. There were 23 patients that underwent a concurrent abdominal procedure (59%), and 22 hernia repairs involved lysis of adhesions (considered distinct from concurrent procedures). The average hernia defect size was 219.95 cm2. One defect was closed primarily. The remaining 38 repairs incorporated mesh, with plane placements as follows: 15 onlay, four sublay, and 16 underlay. Mesh types included synthetic (19), biosynthetic (16) and biologic (2). Two patients experienced post-operative cellulitis (5.1%), five had a surgical site infection (SSI) (12.8%), and three encountered delayed healing (7.7%). There was a total of 11 recurrences (28.9%), with average time to recurrence of 724 days [203 days, 2022 days]. Mean follow-up was 2.7 years [18 days, 9.5 years].

Conclusion: Flank hernias represents a unique and challenging situation for reconstruction. Defect size, location, and proximity of surrounding structures are driving factors in its repair. We describe 39 flank hernia repairs, with an average follow-up of 2.7 years with a recurrence rate of 29%. Recurrence rates described in the literature, though decreased, reflect more ideal patient populations with frequent retromuscular and/or bone-anchored mesh repairs. Although this represents a limited cohort, outcomes analysis of flank hernias are sparse, and future investigations are warranted.

Reconstructive

PSTM 2024