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Not Just an Aside: A Retrospective Review of Flank Hernia Repair Outcomes
Zachary Gala
*, Linda Saikali, Mehdi S. Lemdani, Jane N. Ewing, Chris Amro, Niv Milbar, Daniel Mazzaferro, Robyn B. Broach, John P. Fischer, Stephen J. Kovach
Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA
Introduction: Flank hernias, a lateral abdominal wall hernia subclass defined by the European Hernia Society, are less common than midline hernia. Lateral incisions for retroperitoneal access compromise muscular integrity and lead to subsequent herniation. Outcomes are ill-defined and no consensus abdominal wall closure technique exists. Herein, we examine flank hernia repair outcomes at our institution.
Methods: All ventral hernia repairs performed by the senior authors from October 2013 - January 2023 were retrospectively reviewed. Operative reports were used to select only flank hernias. Demographic, comorbidity, perioperative, and surgical outcome-related information was collected.
Results: There were 48 flank hernias (25 male, 23 female) total. The average age was 60 ± 11.8 years and average BMI was 31.1 ± 6.1. About 44% of patients were current/former smokers, and 60.9% were classified as ventral hernia wound group (VHWG) 2. Patients had a mean 2.1 prior abdominal surgeries, and 33% patients had at least one prior hernia repair. Two and five patients had prior mesh and wound infections, respectively. Concurrent abdominal procedures (51.1%) and adhesiolysis (56.3%) were common. The average defect size was 280.8 cm2. With two primary closures, 46 repairs incorporated mesh (synthetic (n=21), biosynthetic (n=21) and biologic (n=2)) in the following planes: onlay (n=18), sublay (n=8), and underlay (n=17). Adverse events included cellulitis (n=3, 6.5%), surgical site infection (n=5, 10.4%), and delayed healing (n=3, 6.2%). Total recurrence was 23.4% (n=11), occurring at a mean 1.98 years [203 days, 5.40 years]. Mean follow-up was 2.27 years [18 days, 9.50 years]. Medical comorbidities, mesh type/plane, or perioperative factors did not significantly predict outcomes.
Conclusion: Our recurrence rate corroborates the complexity of flank hernia repair, which warrants consideration of factors such as BMI, defect size, prior herniorrhaphy, medical comorbidities, and mesh placement. Outcomes analysis of flank hernias is sparse, with future investigations warranted.
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