الفهرس 
Surgical AnatomyOnly 14 pages are availabe for public view
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Abstract
Lumbar hernias occur in the flank and are most often acquired spontaneous, posttraumatic, or postoperative) rather than congenital. Symptoms are absent, variable, or confusing because post incisional neuralgia may be indistinguishable from pain caused by a lumbar hernia. A flank bulge may be detectable, but the clinical diagnosis can be very difficult in obese and postoperative patients.
Flank bulge is one of the most common complications of flank approach to the kidney; Post-operative lumbar hernia is also one of the most annoying complications of the renal surgery. So, the present work aimed to determine the peri-operative risk factors for occurrence of both hernia and bulge.
The risk factors for occurrence include factors related to patient’s status, underlying disease, surgical technique and postoperative complications. Surgical technique of wound closure also plays a role. Perioperative factors appear to have the most significant correlation to incisional hernia formation, with wound infection being the most consistently reported risk factor. Other perioperative factors include deep abscesses, perioperative gastrointestinal complications and early reoperations.The aim of this study was to evaluate the incidence and risk factors of development of lumbar incisional hernia and flank bulge after lumbar incision.
This study was carried out on 150 patients underwent variable renal surgeries through flank approach, 50 of them had incomplete records and excluded from the study, 100 patients were included in this study and the results were presented and analyzed.
The outcome of operation was identified as:
1. 76 patients didn’t develop bulge or hernia.
2. 14 patients developed flank bulge.
3. 10 patients developed lumbar hernia All patients were subjected to the following:
Preoperative assessment:
History taking (Age, Sex, smoking, history of previous operations and chronic diseases like DM, COPD).
Life style, Exercise.
History of GIT motility disorders like constipation.
Thorough clinical examination with emphasis on performance (WHO score), built, height, weight and body mass index
Patient photographing in the erect position (AP view).
Hemoglobin level, Liver and kidney function tests.
Recording of intraoperative data:
Name of the operation, Surgeon years of experience, Duration of surgery, Approach to the kidney, Length of incision, Use of self-retaining retractor , Muscle division method, Neurovascular bundle preservation, Closure of the wound in layers, Suturing technique, suturing material.
Postoperative data:
Follow up of the patient to assess whether the patient will develop lumbar incisional hernia or flank bulge or not and this will be after one and three months.
Ambulation.
If there is distension and degree of it if present.
Return to physical activity after how much time in days.
Photographing the patient in the erect position (AP view) at one and three months.
Ultrasonography to document presence of incisional hernia or not.On analysis of the results and correlating different factors for the outcome of operation; we found that the significant factors for the occurrence of bulge or hernia were: age, BMI, performance score, constipation, hemoglobin level, serum creatinine and length of incision.
The significant risk factors were included in the multivariate analysis using a Cox regression analysis. Two independent risk factors for occurrence of post-operative lumbar hernia and bulge following flank approaches to the kidney were identified including age of 47.3 or higher with confidence interval of 0.54-2.84 and P value 0.04, BMI 28.6 kg/m2 or higher with confidence interval of 0.91-5.32 and P value 0.01.