Surgical repair of the abdominal bulge: Correction of a complication of the flank incision for retroperitoneal surgery

Hoffman, Ryan S.; Smink, Douglas S.; Noone, R. Barrett; Smink, Robert D.

doi:10.1016/j.jamcollsurg.2004.07.009

Cited by 28 publications

(25 citation statements)

References 6 publications

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“…7,9,13,21 However, subsequent investigators have not found extension into this space to be a risk factor for developing this complication. 20 More recently, authors have found an association between longer incisions and abdominal flank bulging.…”

Section: Postoperative Abdominal Flank Bulgementioning

confidence: 99%

“…9 Multiple authors have suggested that abdominal flank bulging after retroperitoneal approaches may be a result of denervation injury. 4,7,9,13,14,16,18,21 However, these authors have varied substantially in their recommendations on how to avoid this injury. Some advocate avoiding extension of the incision into the intercostal space between the 11th and 12th ribs.…”

mentioning

confidence: 99%

“…Some advocate avoiding extension of the incision into the intercostal space between the 11th and 12th ribs. 7,9,13,21 Others suggest minimizing the length of the incision. 16,18,20 Several mention the importance of not crossing dermatomes with the incision while simultaneously conceding the difficulty of performing this task.…”

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confidence: 99%

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Avoiding abdominal flank bulge after anterolateral approaches to the thoracolumbar spine: cadaveric study and electrophysiological investigation

Fahim

Kim

Cho

et al. 2011

SPI

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Object The thoracolumbar junction is frequently accessed through an anterolateral approach with the incision and muscle dissection extending from the lower thoracic region to the lateral border of the rectus abdominis muscle. This approach is frequently associated with the subsequent development of an unsightly and uncomfortable relaxation of the ipsilateral abdominal wall, or flank bulge, caused by denervation injury to the intercostal nerves. However, the etiology of this complication is not widely recognized by spine surgeons. The object of this study was to better define the relevant anatomy and innervation of the anterolateral abdominal wall musculature. Methods The authors performed 32 cadaveric dissections and 6 intraoperative electromyography (EMG) evaluations. Results The cadaveric dissection studies and intraoperative EMG evaluations provided detailed anatomy of the anterolateral abdominal wall and its innervation. Cadaveric dissections revealed that the most significant intercostal nerve contributions to the anterolateral abdominal wall arise from T11 and T12. Electrophysiological confirmation of these findings was accomplished through intraoperative stimulation in 6 patients undergoing anterolateral retroperitoneal approaches to the thoracolumbar junction. The authors confirmed T11 and T12 innervation of the anterolateral abdominal wall musculature by direct intraoperative EMG recording in all 6 patients. Conclusions The authors classified the 3 potential zones of injury that can be affected during an anterolateral approach to the thoracolumbar junction. Modifications to the operative technique are suggested to avoid the complication of flank bulge. The most significant intercostal nerve contributions to the anterolateral abdominal wall arise from T11 and T12.

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Section: Postoperative Abdominal Flank Bulgementioning

confidence: 99%

mentioning

confidence: 99%

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Avoiding abdominal flank bulge after anterolateral approaches to the thoracolumbar spine: cadaveric study and electrophysiological investigation

Fahim

Kim

Cho

et al. 2011

SPI

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“…In der Literatur finden sich hierzu lediglich Einzelberichte über chirurgische Korrekturmöglichkeiten. In Betracht kommen Verfahren zur Bauchwandstabilisierung in Form einer Kombination aus präperi-tonealer Netzimplantation und gleichzeitiger Bauchdeckenplastik [18].…”

Section: > Die Operative Strategie Muss Individuell Und Interdiszipliunclassified

“…Liegt eine begleitende Narbenhernie vor, besteht grundsätzlich die Indikation zur Revision. Bei einer reinen Bauchwandrelaxation ist die Operationsindikation individuell in Abhängigkeit vom Leidensdruck und den Beschwerden des Patienten zu stellen.Trotz der Häufigkeit dieses Phänomens finden sich in der Literatur nur vereinzelte Angaben zu operativen Versorgungsmög-lichkeiten[18]. Das Prinzip besteht in einer präperitonealen retromuskulären Netzplastik im Bereich der lateralen Bauchwand über den primären Zugangsweg (.…”

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Versorgung von Bauchdeckendefekten einschließlich der Bauchwandrelaxation aus allgemeinchirurgischer Sicht

Langer

Becker

2006

Chirurg

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Abdominal wall defects that are amenable to direct fascial approximation are the indication for retromuscular mesh augmentation. Larger defects can be bridged with meshes used as abdominal wall substitution or with reconstructive flaps. Other options are indirect techniques to achieve primary preparation of the abdominal wall, either by mobilization of the abdominal wall muscles with the component separation method or by preoperative expansion of the abdominal cavity using a progressive pneumoperitoneum. Surgical repair of iatrogenic abdominal wall relaxations should combine plastic reconstruction with preperitoneal mesh implantation. Scientific evidence supporting any treatment option is weak, because few prospective, randomized trial data are available owing to the inhomogeneity of the patient population. Treatment of abdominal wall defects must therefore be proposed on an individual basis utilizing one or a combination of the techniques described.

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Lumbar Hernia

Śmetański¹,

LeBlanc²

2018

Management of Abdominal Hernias

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Surgical repair of the abdominal bulge: Correction of a complication of the flank incision for retroperitoneal surgery

Cited by 28 publications

References 6 publications

Avoiding abdominal flank bulge after anterolateral approaches to the thoracolumbar spine: cadaveric study and electrophysiological investigation

Avoiding abdominal flank bulge after anterolateral approaches to the thoracolumbar spine: cadaveric study and electrophysiological investigation

Versorgung von Bauchdeckendefekten einschließlich der Bauchwandrelaxation aus allgemeinchirurgischer Sicht

Lumbar Hernia

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