Negin Fadaee1, Erfan Zarrinkhoo, BS2, Khadij Assani, BS, BA3, Shirin Towfigh, MD4. 1University of California, Los Angeles, 2Wake Forest School of Medicine, 3AT Still University School of Osteopathic Medicine, 4Beverly Hills Hernia Center
Introduction: The lateral flank approach to lumbar spine surgery is considered a new minimally invasive alternative to the anterior abdominal approach. Flank incisional hernia is one complication. Our aim is to review our experience with repair of these hernias and try to decipher technical reasons for their occurrence so that these can be prevented, with the goal of improving overall outcomes.
Methods: Retrospective review of all patients referred for evaluation of lateral bulging of the abdominal wall after Lateral Interbody Fusion (LIF), from August 2013 to August 2017.
Results: In 4 years, 14 patients were evaluated: 12 were diagnosed with incisional hernias at the LIF access site and 2 with denervation injury without hernia defect.
Conclusions: This is the largest study addressing incisional flank hernias after LIF. This complication is under-represented in the spinal literature (0.17% prevalence). We show that the patients present early postoperatively with their incisional hernia (median 2 months), and yet most hernias are not diagnosed for 16 months. The hernia is typically partial thickness, as the technique for access site closure is single layer closure of the external oblique with rapidly absorbable suture. To help reduce risk of hernia, we recommend closure in multiple layers with slowly absorbable suture; this should include closure of all fascial layers, not just the external oblique.
Although LIF is considered a minimally invasive spinal procedure, the morbidity from hernia complications cannot be overlooked. These hernias are difficult to repair with suboptimal outcomes: ? recurrence and over half with chronic pain. We prefer robotic approach with primary closure of the defect and extraperitoneal sublay mesh.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 92530
Program Number: P555
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster