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PURPOSE: Abdominal bulge after retroperitoneal dissection occurs at a rate of 7-12%. T11 nerve injury results in muscular denervation and symptomatic bulge. Increasing use of the retroperitoneal approach for lumbar spine surgery has increased the incidence of abdominal bulge. Current repair techniques fail to address the etiology of laxity and outcomes are poorly reported. Recurrence rates in complex abdominal hernia repair exceed 20% with nearly 25% morbidity. We present a method of muscular imbrication and bone anchored mesh fixation for the definitive treatment of abdominal bulge.
METHODS: A retrospective review of consecutive patients who underwent Mitec suture anchor (De Puy, MA) fixation of mesh for abdominal bulge after retroperitoneal dissection between February 2013 and September 2014 was performed. Pre-, intra-, and post-operative records of four patients were reviewed and compared.
RESULTS: There were no reported recurrences and no peri-operative morbidity or mortality related to the operation. Average follow up was 9 months (range 6-18 months), operative time 157 minutes, length of stay 3.5 days, and EBL 50mL.
CONCLUSION: Reinforcement of the repair using bone anchored fixation of mesh represents a novel approach for the treatment of abdominal bulge after retroperitoneal dissection. Early results demonstrate safety and no early recurrence.

Outcomes after bony fixation of mesh for the treatment of abdominal bulge

Patient	Age	Gender	BMI (kg/m^2)	Indication	Length of Operation	Length of Hospitalization	Mortality
1	74	M	31	Abdominal bulge after L4-S1 ALIF	156	2	None
2	48	M	23	Abdominal bulge after renal transplant	115	3	Cardiopulmonary arrest secondary to metastatic cancer to lungs 8 months postop
3	60	M	22	Recurrent abdominal bulge and pain after L4-S1 ALIF	177	7	None
4	71	F	24	Abdominal bulge and pain after L1-L2 ALIF	178	2	None
Mean	63		25		157	3.5