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Minimally invasive transabdominal preperitoneal repair of incisional lumbar hernia

By Boris

Volume 10, Issue 1

Case Report / Published: July 2022

DOI: https://www.doi.org/10.57045/jemis/1010722.pp47-52

V. Kyosev, P. Ivanov, V. Mutafchiyski, G. Kotashev, K. Vasilev, G. Grigorov, D. Penchev, M. Gavrilov, Ts. Paycheva

Clinic of Endoscopic, Endocrine surgery and Coloproctology, Department of Surgery, Military Medical Academy, Sofia, Bulgaria

Abstract

Introduction: A lumbar hernia is a rare type of abdominal wall defect by anatomic location. It can be primary in origin over the lumbar triangles that can be categorized into superior (Grynfeltt) and inferior (Petit), or secondary as a result of trauma or surgery. Lumbar abdominal wall hernia in which clinical presentations may vary from an asymptomatic bulge in the lumbar area to a symptomatic lumbar mass with back pain. The anatomical location makes challenging diagnosis and repair. Individual approach for every patient is key for successful surgical treatment. In this paper, we present a minimally invasive approach to the treatment of incisional lumbar hernia.

Case presentation: A 75-year-old patient from Pazardzhik town, was admitted to our unit at the Military Medical Academy for swelling in the left lumbar region at the site of an old surgical scar from a previous nephrectomy (2020) caused by nephropathy. The swelling has a one-year history and causes periodic local pain and discomfort during physical exercise.  CT-scan show us an incisional left site lumbar hernia, 10cm defect diameter with descending colon and spleen as hernia contents. We conducted preoperative preparation and consultations with an anesthesiologist, cardiologist and nephrologist. The patient underwent minimally invasive transabdominal preperitoneal lumbar hernia repair with a prosthesis. The postoperative period went smoothly and the patient was discharged on the fourth day. Three months later, he feels well and there is no evidence of recurrence.

Conclusions: Preoperative CT-scan of the abdomen with contrast in lumbar hernia patients is a mandatory requirement for proper diagnosis and selection of an appropriate surgical approach. Minimally invasive transabdominal preperitoneal incisional lumbar hernia repair provides an optimal view in the operative field, minimal tissue trauma, fast recovery and good cosmetic results. This is a new method, but a feasible, useful and safe alternative to conventional surgical techniques for incisional lumbar hernia repair.

 

References

  1. Stamatiou D, Skandalakis JE, Skandalakis LJ, Mirilas P. Lumbar hernia: surgical anatomy, embryology, and technique of repair. Am Surg. 2009;75(3):202–7.
  2. Barbette P. Opera chirurgico-anatomica. Lugduni J a Gelder. 1672: 26.
  3. DeGarangeor RJC. Traie des operations de chirurgie. 1731;1: 369.
  4. Macchi V, Porzionato A, Morra A, et al. The triangles of Grynfeltt and Petit and the lumbar tunnel: an anatomo-radiologic study. Hernia. 2017;21(3):369–76.
  5. Pang RR, Makowski AL. Inferior lumbar triangle hernia with incarceration. Am J Emerg Med. 2019;37(6):1218.e5-1218.e6.
  6. Fokou M, Fotso P, Ngowe Ngowe M, Essomba A, Sosso M. Strangulated or incarcerated spontaneous lumbar hernia as an exceptional cause of intestinal obstruction: case report and review of the literature. World J Emerg Surg. 2014;9:44.
  7. Van Steensel S, Bloemen A, van den Hil LCL, van den Bos J, Kleinrensink GJ, Bouvy ND. Pitfalls and clinical recommendations for the primary lumbar hernia based on a systematic review of the literature. Hernia. 2019;23(1):107–17.
  8. Beffa LR, Margiotta AL, Carbonell AM. Flank and lumbar hernia repair. Surg Clin North Am. 2018;98(3):593–605.
  9. Kadler B, Shetye A, Patten DK, Al-Nowfal A. A primary inferior lumbar hernia misdiagnosed as a lipoma. Ann R Coll Surg Engl. 2019;101(4):e96–8. https:// doi.org/10.1308/rcsann.2019.0009.
  10. Hafner CD, Wylie JH, Brush BE. Petit’s lumbar hernia: repair with Marlex mesh. Arch Surg. 1963;86:180–6. https://doi.org/10.1001/archsurg.1963. 01310080004002.
  11. Moreno-Egea A, Torralba-Martinez JA, Morales G, Fernandez T, Girela E, Aguayo-Albasini JL. Open vs laparoscopic repair of secondary lumbar hernias: a prospective nonrandomized study. Surg Endosc. 2005;19:184–7.
  12. Moreno-Egea A, Alcaraz AC, Cuervo MC. Surgical options in lumbar hernia: laparoscopic versus open repair. A long-term prospective study. Surg Innov. 2013;20:331–44.
  13. Shekarriz B, Graziottin TM, Gholami S, Lu HF, Yamada H, Duh QY, et Transperitoneal preperitoneal laparoscopic lumbar incisional herniorrhaphy. J Urol. 2001;166:1267–9.
  14. Edwards C, Geiger T, Bartow K, Ramaswamy A, Fearing N, Thaler K, et al. Laparoscopic transperitoneal repair of flank hernias: a retrospective review of 27 patients. Surg Endosc. 2009;23:2692–6.
  15. Arca MJ, Heniford BT, Pokorny R, Wilson MA, Mayes J, Gagner M. Laparoscopic repair of lumbar hernias. J Am Coll Surg. 1998;187:147–52.
    Postema RR, Bonjer HJ. Endoscopic extraperitoneal repair of a Grynfeltt hernia. Surg Endosc. 2002;16:716.
  16. Habib E. Retroperitoneoscopic tension-free repair of lumbar hernia. Hernia. 2003;7:150–2.
    Meinke AK. Totally extraperitoneal laparo-endoscopic repair of lumbar hernia. Surg Endosc. 2003;17:734–7.
  17. Moreno-Egea A, Guzman P, Girela E, Corral M, Aguayo Albasini JL. Laparoscopic hernioplasty in secondary lumbar hernias. J Laparoendosc Adv Surg Tech A. 2006;16:572–6.
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Keywords:

Incisional lumbar hernia, Preperitoneal repair, Hernia with rare location

How to cite this article:

Kyosev V, Ivanov P, Mutafchiyski V, Kotashev G, Vasilev K, Grigorov G, Penchev D, Gavrilov M,  Paycheva Ts. Minimally invasive transabdominal preperitoneal repair of incisional lumbar herniа. Journal of Endourology and Minimally Invasive Surgery (Bulgaria), 2022; 10(1):47-52

Corresponding author:

Dr. V. Kyosev

Clinic of Endoscopic, Endocrine surgery and Coloproctology, Department of Surgery

Military Medical Academy of Sofia

Address: 3, Sv. Georgi Sofiyski blvd, 1606, Sofia

E-mail: dr_kyosev @ abv.bg