Flank incisional hernia after lateral approach spine operations: presentation and outcomes after repair

Lateral abdominal wall hernias after coughing: a single center experience

PURPOSE

Forceful coughing is assumed to be an uncommon etiology for lateral abdominal wall hernias. The literature regarding this topic is very limited and there is a lack of consensus in management, both operative and non-operative. We aim to report our center's experience in repair of lateral abdominal wall hernias secondary to vigorous coughing.

METHODS

All patients undergoing lateral abdominal wall hernia repairs secondary to coughing at our institution from August 2014 to December 2023 were identified in the Abdominal Core Health Quality Collaborative (ACHQC). Only patients with lateral abdominal wall hernias without prior lateral incisions, reporting a vigorous coughing event were included in the analysis. Recurrent repairs were also included. Patient and hernia characteristics, operative details, post-operative outcomes, and long-term patient reported outcomes were extracted from the ACHQC database and chart review.

RESULTS

Twelve patients with lateral abdominal wall hernias secondary to coughing underwent repair within the study period. The median hernia width was 18.5 cm. Transversus abdominus release was performed in all patients, 8 had heavyweight polypropylene mesh placed, and 9 received mesh fixation. Wound complications were noted in 2 patients, both resolved with superficial wound opening. At a mean follow up of 4.0 years, one patient reported a bulge, and no clinical or radiographic recurrences were identified.

CONCLUSION

Lateral abdominal wall hernias after forceful coughing have not been well defined. Here we present our series based on our repairs. Unfortunately, our ability to comment on recurrences is limited by a lack of follow up.

New technique of En bloc vertebral resection in the thoracolumbar region assisted by retroperitoneal laparoscopy in a single prone position: first results

PURPOSE

To describe the technique and review the oncological and surgical results of the En Bloc resection assisted by retroperitoneal laparoscopy in a single prone position for tumors in the thoracolumbar region.

METHODS

Monocentric retrospective case study. Procedure was performed in a single prone position by a dual team of spine and thoracovascular surgeons. An endoscopic balloon was inflated in the right retroperitoneal cavity. A plan was developed between the anterior spine and vena cava as well as abdominal aorta with segmental vessels ligation. Structures at risk were safely protected under endoscopy during horizontal or sagittal osteotomies.

RESULTS

From 2021, seven patients aged a median 52 years old (range, 34-67) were included. Involved spinal segments went from T11 to L3. Surgery was aborted in one case due to massive bleeding and ventilating difficulties. There were two partial and four total vertebral resections. Median operating duration and estimated blood loss were 405 min (range, 360-540) and 2.1 L (range, 1.2-19), respectively. Postoperative complications consisted of 1 urinary infection; 1 transient urinary retention; 1 posterior wound infection; 1 pneumothorax; 1 persistent partial motor deficit; 1 transient confusion; 1 pulmonary embolism; 1 CSF leak; 1 subdural hematoma; 1 retroperitoneal lymphocele. All margins were uncontaminated. All patients were alive and ambulatory at last follow-up.

CONCLUSION

Early results suggest En Bloc resection assisted by retroperitoneal videoscopy in tumors from T11 to L3/4 disk space is feasible, less invasive and safe. Careful surgical planning and experience in endoscopic vascular surgery are mandatory.

Robotic versus open lateral abdominal hernia repair: a multicenter propensity score matched analysis of perioperative and 1-year outcomes

PURPOSE

Lateral abdominal hernias are inherently challenging surgical entities. As such, there has been an increase in the adoption of robotic platforms to approach these challenging hernias. Our study aims to assess and compare outcomes between open (oLAHR) and robotic (rLAHR) lateral abdominal hernia repair using a national hernia-specific database.

METHODS

A retrospective review of prospectively collected data from the Abdominal Core Health Quality Collaborative was performed to include all adult patients who underwent elective lateral hernia repair. A propensity score match analysis was conducted, and univariate analyses were conducted to compare these two surgical modalities across perioperative timeframes.

RESULTS

The database identified 2569 patients. Our analysis matched 665 patients to either the open or robotic groups. The median length of stay, surgical site occurrences (SSO), and surgical site occurrences requiring procedural interventions (SSOPI) were higher in the oLAHR versus the rLAHR group. Overall, oLAHR had a significantly higher rate of having any post-operative complications or any SSO/SSOPI. There was no difference in quality-of-life measures between groups at 30 days and 1 year.

CONCLUSION

Robotic abdominal hernia repair is a safe alternative compared to the open repair of lateral abdominal hernias with better perioperative outcomes. Despite having a longer operative time, the robotic approach can offer a significantly shorter length of stay and an overall lower rate of complications. Ultimately, there is no difference in the quality-of-life measures both at 30 days and 1 year between the open and robotic approaches.