Current understanding of abdominal bulge with a novel classification: A retrospective study

Studies on abdominal bulge, also known as flank bulge or pseudohernia are relatively lacking. Retrospectively based on our experience, the incidence and outcomes of abdominal bulges are analyzed and a classification and algorithm of management is provided. A retrospective review was conducted on 46 patients diagnosed with abdominal bulge between 2014 and 2023. Abdominal bulge repair surgeries were performed in 40 (86.9 %) patients. Patient characteristics, including etiology, surgical history, postoperative length of stay, CT based abdominal bulge profile, surgical methods, complications, and recurrences was collected and analyzed. Based on the extent of the bulging abdominal muscle, patients were categorized into Type I: Whole bulging in the anterior or lateral abdominal wall muscle layers and Type II: Partial bulging in the anterior or lateral abdominal wall muscle layer. 40 patients were included in this study. The average postoperative stay was 19.7 ± 21.3 days. Complications occurred in 35 % of patients, with seroma (12.5 %) being the most common. Recurrence was observed in 17.5 % of patients. Patients were categorized as: type IA (10 %), type IB (17.5 %), type IIA (42.5 %), and type IIB (30 %). All type IA patients underwent muscle plication with mesh. For type IB, 42.9 % underwent CST/TAR with mesh and 57.1 % underwent autologous flaps with mesh. All type IIA patients underwent muscle plication with mesh. For type IIB, 25 % underwent CST/TAR with mesh, 66.7 % underwent autologous flaps with mesh, and 8.3 % underwent muscle plication without mesh. Reconstructive strategies must be tailored for all patients based on precise classifications and patient's specific conditions, so that the anatomic and physiological status of atrophied or lost abdominal tissues can be restored close to normal.