Laparoscopic retro muscular lumbar hernia repair using an extended totally extraperitoneal (eTEP) approach: how do we do it?

Abstract

: Lumbar hernias are infrequent defects of the posterior abdominal wall, located between the 12th rib and the iliac crest. These types of hernias are classified as congenital, spontaneous, traumatic, and incisional. The lumbar hernias generally protrude through two anatomical regions: the superior lumbar triangle of Grynfeltt-Lesshaft and the inferior lumbar triangle of Petit. Although they are usually small defects, they can be very symptomatic and a real surgical challenge even for experienced surgeons. Many techniques have been described for the surgical treatment of these hernias, but there is still no gold standard for multiple reasons. The extended totally extraperitoneal (eTEP) technique consists of a series of maneuvers and operative strategies aimed at enhancing the extraperitoneal space for a minimally invasive repair of ventral, inguinal, and lumbar hernias, in a safe and effective manner. This manuscript describes our technique for a lumbar hernia repair done through an eTEP approach. We have adopted since 2018 the eTEP approach for inguinal and ventral hernia repair and have found these approaches very reproducible and ergonomic, after almost 100 inguinal and 50 ventral cases, this experience helped us extrapolate the skills and competence to tackle down a lumbar hernia defect using an eTEP approach.