Treatment of Atypical Hernias

Hernias abutting the bony landmarks of the abdominal wall represent unique repair challenges due to difficulty in obtaining wide mesh overlap, durable prosthetic fixation, and a tension-free fascial closure. While the basic principles of repairing these defects are no different than those for midline hernias, the surgeon addressing such atypical hernias must have a firm grasp of relevant anatomy and additional technical expertise to safely implement a durable herniorrhaphy. This chapter reviews the pertinent anatomy, describes necessary technical steps, and reviews repair results (when available) for “atypical hernias,” including subxiphoid, suprapubic, subcostal, and flank locations. Particular emphasis is placed on options for obtaining wide mesh overlap with bony prominences and options for securing the mesh, including the use of sutures, bone anchors, and tissue sealants.