Simplified Repair of Traumatic Iliac Crest Flank Hernias with Mesh Strips

Abstract

Background: Traumatic abdominal wall hernias are rare injuries resulting from blunt abdominal trauma. Traditional approaches have included both open and laparoscopic approaches, with placement of large meshes with giant overlaps. Perhaps the most technically difficult aspect of these repairs is fixating the abdominal wall to the iliac crest. The senior author has developed a method of repair using 2-cm strips of mesh. In this article, we present a description of 4 patients treated with this technique. Methods: We included 4 adult patients who underwent traumatic flank hernia repairs by the senior author. We excluded incisional hernias and patients who received a planar sheet of mesh. Demographics and outcomes collected included length of stay, follow-up time, and complications. Results: The average age was 38.5 years. Three hernias were due to motor vehicle collision injuries, and 1 was a crush injury at work. No planar meshes or bone anchors were used. No patients required component separation. There were no instances of surgical site infection, hematoma, or wound breakdown. All repairs were intact at the time of last follow-up (average, 24.3 months; range, 4–48.7 months). Conclusions: Traumatic flank hernias are rare injuries that can be difficult to address. Here, we describe a technique of primary repair with mesh strips that distribute the forces of repair across a greater surface area than can be achieved with sutures. Placing drill holes through the iliac crest avoids the cost and complexity of suture anchors.

Repair of traumatic flank hernia with mesh strip suture: a case report

“…According to another report on 107 mesh sutured repairs of abdominal wall defects published in 2016 [22], the recurrence rate (early mean follow-up time of 234 days) was < 4%, and the incidence of surgical site occurrence (infection, seroma, hematoma, reoperation, delayed wound healing) was 17%. Another study published in 2020 reported that among four patients with traumatic flank hernia who underwent mesh strip repair [6], there were no complications such as surgical site infection, hematoma, or wound breakdown and no recurrence during…”

“…The most important outcome in hernia repair is the recurrence rate. Table 1 summarizes 18 case series regarding lumbar hernia (including flank hernia) repair targeting a total of 526 patients reported in the literature [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. An open approach was performed in 13 studies, a laparoscopic approach in three studies, a combination of both approaches in one study, and a laparoscopic or robotic approach in one study.…”

“…The definition of chronic pain is not clear; therefore, it might have been difficult to differentiate between chronic and postoperative pain [4]. Some studies did not assess chronic pain, which might be a reason for the wide range of prevalence of chronic pain in the cases [2,6,7,10,13,15,18]. Using the experimental pig model, a study introduced the mesh sutured repair in 2014 and compared it with standard primary suture [21].…”

“…Flank hernias occurring after blunt abdominal trauma are rare. Approximately 500 cases have been reported in the literature [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. In 2009, the European Hernia Society divided lateral hernia into four zones: L1 (subcostal), L2 (flank), L3 (iliac), and L4 (lumbar) [19].…”

“…Traumatic flank hernia repair has been reported only in case series; thus, surgical techniques or long-term outcomes have not been established. Kearney et al [6] reported that primary repair of traumatic flank hernia using mesh strips provides high tension directly to the hernia defect site and has a low recurrence rate due Repair of traumatic flank hernia with mesh strip suture: a case report to force distribution at the suture site. In addition, compared to conventional hernia repair, the range of tissue dissection for repair using mesh strips is not wide, so the risk of damage to surrounding structures is low [6].…”