NYMC Faculty Publications

Management of Flank Complex Hernia

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Book Chapter

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Flank or lateral incisional hernias are very rare but may be very challenging to manage them. To handle these hernias a previous classification, an early diagnosis, and a tomography are necessary. Delaying surgery only prolongs the patient’s suffering, aggravates the problem, and worsens the prognosis. Knowledge about the topographic anatomy is essential to perform surgery safely. The dissection of the bone edges and medial areas (rectus sheath) is difficult and limited. Fixation on these areas must be firm. The laparoscopic approach is a safe option for small or moderate defects in patients with BMI <30. For subcostal hernias an open approach is safer. Large hernias (>15 cm) and on obese patients this approach should be preferred and the double-mesh technique is the best choice. As with other complex abdominal wall hernias, we advise that patients with complex lateral hernias should be treated in specialized units.