Laparoscopic Repair of Traumatic Flank Hernia

Introduction: Traumatic flank hernias are caused by a blunt abdominal trauma with resultant detachment of the oblique musculofascial complex at the iliac crest and/or costal margin. Given such proximity to the bony structures and essential absence of the healthy fascia to anchor the mesh, traumatic flank hernias represent a challenging surgical problem. Although laparoscopic repair of ventral hernias has become very common, laparoscopic approach to traumatic flank hernias has not been established well. We present a video detailing the technique of laparoscopic repair of traumatic flank hernia.

Methods: The patient was placed in the decubitus position. Entrance to the abdomen was performed using Optiview trocar in the subcostal area. Operative steps included a complete reduction of the hernia sac, pre/retroperitoneal dissection to expose the entire lateral edge of a psoas muscle, defect closure with trans-abdominal sutures, wide mesh overlap, transabdominal suture fixation followed by the use of Mitek bone anchors.

Results: The operative time was 180 minutes. Estimated blood loss was 100ml. The defect size was 12 cm x 6 cm and the size of the mesh used was 20cm x 15cm. There were no perioperative complication. Hospital stay was 5 days. The patient returned to full activities by 1 month. At follow-up of11 months, there was no recurrence.

Conclusions: Laparoscopic approach to traumatic flank hernia is feasible and safe. It is associated with minimal hospital stay and fast functional recovery. The key components of our approach include wide pre/retro-peritoneal dissection with subsequent wide mesh coverage with mandatory fixation to bony structures using anchors/screws. We believe the laparoscopic approach should be considered for most patients with traumatic flank hernias.

Session: Podium Video Presentation

Program Number: V018