The Management of Traumatic Abdominal Wall Flank Hernia Along the Spigelian Aponeurosis Using Component Separation, Synthetic, and Biological Mesh

Abstract

Blunt abdominal trauma is associated with a variety of medical complications. Traumatic abdominal wall hernias (TAWHs) are a rare sequela of blunt trauma. Of the various forms of TAWH, a rare subtype described as a "spontaneous lateral ventral hernia" or flank hernia occurs in less than 1% of all blunt abdominal traumas. We present a case of a 39-year-old male with a past medical history of epilepsy who was involved in a rollover motor vehicle collision. It was reported that the patient had a seizure while driving. On physical exam, the patient had a large left lower flank contusion. Computed tomography revealed a complex TAWH with complete avulsion of the abdominal wall musculature from the iliac crest and near to total disruption of the internal oblique. To address this, we used a biological mesh inlay, reinforced with a synthetic Ventralight™ mesh secured to the iliac crest. In this article, we describe the patient's experience and management of a complex TAWH.

Lateral abdominal wall hernia: A surgeon’s dilemma

“…As surgical correction is always more difficult in advanced cases, surgery must be indicated as early as possible. Before going for any procedure we should establish a complete diagnosis in terms of knowing the size, location, and contents of the defect and for this reason, it is advisable to have CT available before planning a surgery [3,4] .…”

“…The reconstruction is planar as opposed to the curvilinear or convex form of the native LAW. The goal is to reinforce the entire hem-abdominal wall with fixation to anatomic structures that will not stretch or attenuate over time [4,5] . The core surgical principles of ventral hernia repair apply to lateral abdominal wall reconstruction.…”

“…The laparoscopic approach has the advantage of being minimally invasive(less pain, shorter length of hospital stay, and fewer wound complications); it also avoids major dissections, allows exact location of the lesion, and offers an excellent visualization, thus avoiding possible lesions to neighboring structures. However, the laparoscopic approach does not allow for parietal reconstruction or repair under controlled tension [4,6] . A hernioplasty via the anterior approach or using extra peritoneal laparoscopy on small defects with extra peritoneal contents; the trans abdominal approach on moderate defects with paraperitoneal or intraperitoneal hernias and an anterior repair with a multiple mesh or in cases of recurrence or diffuse hernias larger than 15 cm is reco mmended.…”