Incidence, etiology, management, and outcomes of flank hernia: review of published data

Purpose: To review the published data describing the incidence, etiology, management, and outcomes of flank hernia. Methods: A retrospective review of articles identified with an online search (using the terms “flank hernia”, “flank bulge”, “lateral hernia”, “retroperitoneal aorta hernia”, and “open radical nephrectomy”) was performed. Studies exclusively on lumbar hernia or subcostal hernia were excluded. Results: All articles retained for analysis (N = 26) were uncontrolled series or case reports; there were no controlled trials. The incidence of incisional hernia in the flank was ~ 17% (total patients analyzed = 1,061). Flank hernia repair was accomplished successfully with a variety of techniques, with overall mean rates of perioperative complications, chronic post-procedure pain, and recurrence equal to 20, 11, and 7%, respectively. Mesh utilization was universal. Conclusions: The available data of outcomes of flank hernia repair are not of high quality, and recommendations essentially consist of expert opinions. Operative approach (open vs. laparoscopic) and mesh insertion details have varied, but reasonable results appear possible with a number of techniques.