Successful laparoscopic repair of a lumbar hernia occurring after iliac bone harvest

Retroperitoneal totally endoscopic prosthetic repair of lumbar hernia

Lumbar hernia is a rare lateral abdominal wall hernia. Various surgical repair strategies have been recorded, but there is currently no unified standard. A Chinese surgeon recently revealed a novel technique for treating primary lumbar hernia called retroperitoneal totally endoscopic prosthetic repair (R-TEP). We have made a further exploration of this method and successfully used it in the treatment of secondary lumbar hernia. We successfully performed R-TEP on three patients with lumbar hernias. All patients were female with an average age of 64 years (51-71 years). Two patients each had a primary upper lumbar hernia, while one patient had a secondary lumbar hernia. With a mean operative time of 77 min (60-105 min), all operations were performed successfully. The average visual analogue scale (VAS) was 1.3 points (1-2 points) on the second day following surgery. The mean postoperative hospital stay was 2.3 days (2-3 days). No postoperative complications occurred. During a mean follow-up period of 19 months (10-24 months), there was no recurrence of the hernia, chronic pain or mesh infection. Therefore, R-TEP is safe and effective for both primary and secondary lumbar hernia. Anti-adhesive coated meshes are not required, making this a cost-effective procedure that is worthy of recommendation.

Lumbar hernia diagnosed after laparoscopic hiatal hernia surgery

The presence of a new lumbar swelling or pain in the postoperative period following laparoscopic surgery should raise the suspicion of a lumbar hernia. Cross-sectional imaging can be used to establish an early diagnosis to enable successful management.

Reoperation with laparoscopic mesh repair for recurrent lumbar hernia due to iliac crest bone harvest

Previous reports have described laparoscopic mesh repair for lumbar hernia due to iliac crest bone harvest, but there have been no reports of reoperation with laparoscopic mesh repair for recurrent cases after laparoscopic mesh repair. Here, we describe the case of a 72-year-old Japanese woman with lumbar hernia recurrence 6 years after laparoscopic mesh repair for lumbar hernia due to iliac crest bone harvest. We performed a successful reoperation with laparoscopic mesh repair. Laparoscopic surgery should be considered to elucidate the mechanism of recurrence, previous mesh position, and the area that must be covered to prevent recurrence again.

Bilateral Lumbar Hernias Following Spine Surgery: A Case Report and Laparoscopic Transabdominal Repair

Lumbar hernias are rare abdominal wall defects. Fewer than 400 cases have been reported in the literature and account for 2% of all abdominal wall hernias. Lumbar hernias are divided into Grynfelt-Lesshaft or Petit hernias. The former are hernia defects through the superior lumbar triangle, while the latter are defects of the inferior lumbar triangle. Primary lumbar hernias are further subdivided into congenital or acquired hernias and can further be classified as either primary or secondary. Secondary hernias occur after previous flank surgeries, iatrogenic muscular disruption, infection, or trauma. We review a rare presentation of metachronous symptomatic bilateral secondary acquired lumbar hernia following spine surgery. A successful laparoscopic transabdominal lumbar hernia repair with extraperitoneal mesh placement was performed, with resolution of the hernia symptoms. An extensive literature review regarding lumbar hernia and different types of repairs was performed.

Sublay repair for primary superior lumbar hernia with the Kugel patch

Background

A superior lumbar hernia is a posterior ventral hernia that is rarely encountered in the clinical setting. However, no standard operative strategy exists for superior lumbar hernia repair at present.

Methods

Twelve patients with primary superior lumbar hernia who underwent sublay repair via the retroperitoneal space with the Kugel patch between December 2008 and June 2019 were included in this study. The demographic, peri‐operative and post‐operative data of the patients were collected to analyse the effectiveness of this technique.

Results

All patients underwent an uneventful operation. The median operative time was 60 min, and the median blood loss was 35 mL. The median hernia defect area was 16 cm². Five medium‐sized Kugel patches (11 cm × 14 cm) and seven large‐sized Kugel patches (14 cm × 17 cm) were used for the repairs. The median visual analogue scale score on post‐operative day 1 was 3. The median time to removal of drainage was 3 days. The median duration of the hospital stay was 3 days. No serious post‐operative complications, including seroma, haematoma, incision or mesh infection, recurrence and chronic pain, occurred during the follow‐up period.

Conclusion

Sublay repair for primary superior lumbar hernia with the Kugel patch shows benefits including a reliable repair, minimal invasiveness and few post‐operative complications.

Laparoscopic mesh repair for lumbar hernia after iliac crest bone harvest

Lumbar hernia after iliac crest bone harvest is relatively rare. When it does occur, it presents as a flank abdominal protrusion through a lateroposterior abdominal wall defect. A laparoscopic approach for this type of hernia is reported to have advantages over the classic open method. Here, we present a case of a 49-year-old Caucasian man who presented with an enlarged left flank mass after iliac bone harvest for pseudarthrosis. He had undergone open onlay mesh repair for inferior lumbar hernia, but the hernia recurred 3 months postoperatively. Laparoscopic intraperitoneal onlay mesh repair using a composite mesh was performed 7 months after recurrence. The patient was discharged 6 days postoperatively without complications. No signs of recurrence were detected during 1-year follow-up period. The laparoscopic approach for lumbar hernia conferred excellent visualization of the hernia defect and enabled a safe mesh repair using intra-abdominal pressure to hold it in position. This approach provided all the benefits of minimally invasive surgery.

Implementation of the trans-abdominal partial extra-peritoneal (TAPE) technique in laparoscopic lumbar hernia repair

Background

There is still not any standardized operative strategy that is well-accepted all over the world for lumbarhernia. We are here to investigate the feasibility of the trans-abdominal partial extra-peritoneal (TAPE) technique in lumbar hernia repair.

Methods

The TAPE technique was applied to 14 patients with lumbar hernia from May 2009 until January 2014. The surgical technique was described in details and follow-ups were performed for further evaluation.

Results

The mean age of the 14 patients was 68 ± 8 years, with the average BMI 25.5 ± 2.1 kg/m². The etiology study showed that 13 cases after surgical operations and one case after trauma. The average size of the hernia defect was 86.8 ± 46.4 cm², while the mean size of the mesh implanted was 275 ± 61.2 cm². The mean operative time was 59.2 ± 8.2 min. There was no intra-operative visceral injury in this serial of cases. There was no conversion case and all patients accepted the TAPE technique successfully. The VAS was 3.8 ± 1.9 and 2.2 ± 1.6 on POD1 and POD3, respectively. The mean post-operative hospital stay was 4.0 ± 1.3 days. The median follow-up time was 33 months. All patients returned to unrestricted movement within 2 weeks after surgery. During the follow-ups, no complication as bulge, seroma, hematoma, wound infection, abscess in surgical area and chronic pain, nor recurrence was observed.

Conclusions

According to our experience in this series of investigations, the TAPE could be a feasible and easy-to-learn technique which can be applied to most of the lumbar hernia repairs.

Single-incision laparoscopic total extraperitoneal repair for a Grynfeltt hernia: a case report

Introduction

A superior lumbar hernia, which is also known as a Grynfeltt hernia, is a rare abdominal wall defect that can be primary or secondary to trauma or orthopedic surgery. The anatomic location of a lumbar hernia makes diagnosis and repair challenging. We successfully repaired a lumbar hernia using a single-incision laparoscopic total extraperitoneal approach. To the best of our knowledge, this is the first report of the use of this surgical technique in the treatment of a primary Grynfeltt hernia.

Case presentation

A 76-year-old Taiwanese man presented to our hospital with a left lower bulging mass noted for over three months. Abdominal computed tomography revealed a left Grynfeltt hernia. We performed a single-incision laparoscopic total extraperitoneal repair. Our patient was discharged uneventfully on the fourth day after the operation. There was no evidence of recurrence after six months of follow-up.

Conclusion

A laparoscopic total extraperitoneal repair for a lumbar hernia provides an excellent operative view and minimal invasiveness. The single-incision technique also provides better cosmetic outcomes. Our experience suggests that the single-incision laparoscopic total extraperitoneal approach may be a feasible and safe alterative to conventional approaches in lumbar hernia repair.

Surgical options in lumbar hernia: laparoscopic versus open repair. A long-term prospective study

OBJECTIVE

To determine the safety and effectiveness of laparoscopic lumbar hernia repair.

DESIGN

Prospective clinical study.

SETTING

Abdominal wall unit, university hospital.

PATIENTS

Between January 1995 and December 2008, data from 55 consecutive patients who had undergone laparoscopic (n = 35) or open (n = 20) lumbar hernia repair.

MAIN OUTCOME MEASURES

The primary endpoint was recurrence; secondary endpoints were patient outcomes (morbidity, pain, and return to normal activity).

RESULTS

Mean operating time (P = .01), hospital stay, return to normal activity, analgesic consumption, and pain at 1 month (P < .001) were significantly less in the laparoscopic group. Complications were similar in the 2 groups (37% vs 40%, respectively; P = .50). Traumatic hernias increased local complications versus incisional lumbar hernias (71.4% vs 29%; P = .007). Consumption of analgesics (6.8 ± 6.5 vs 18.1 ± 9.1; P < .001) and pain during the first month (no pain: 90% vs 54.3%; P = .015) were significantly less with a lightweight versus medium-weight mesh. The risk factors associated with recurrences development were localization (P = .01) and size (P = .008). Recurrence rates were 2.9% in the laparoscopic group and 15% in the open group (P = .13).

CONCLUSIONS

Outcomes did not differ with respect to morbidity and recurrence rate after long-term follow-up; however, this study suggested that laparoscopic approach for lumbar hernia is safe, effective, and more efficient than open repair and can be considered the procedure of choice. Open surgery may be considered the best option in the diffuse hernias with size larger than 15 cm.