LUMBAR INCISIONAL HERNIA REPAIR-PREPERITONEAL PLACING OF MESH-THE IMPORTANCE OF CT EVALUATION

Abstract

Abstract Background Lumbar hernias can be congenital (primary) or aquired (postoperative and posttraumatic). The margins are well-known: the iliac crest, 12th rib, the erector spinae and the external oblique muscle. The most number of lumbar incisional hernias occur after nephrectomy. Objective To show the results in treatment of lumbar incisional hernias in district General hospital and to review the importance of CT evaluation before and after treatment of lumbar incisional hernias (specially for W3 = the width of hernia defect ≥ 10 cm ≈ large hernias). Methods This is retrospective case-study analysis from June 2005 till November 2021.The mean follow-up for all patients was 36 months. Results From 15 June 2005. to 15 November 2021 we operated 18 patients with diagnosis: Lumbar incisional hernia. 16 patients were operated due to principles of sublay-preperitoneal placing of MESH (all by the same surgeon). In our evaluation we divided the patients in 3 groups according to the width (size) of hernia defect – W1, W2 and W3. For the patients with “large hernias” (W3) – 5 patients, we perform CT of abdomen 3 times (before operation, a few months after operation and 2 or 3 years after operation). All other patients have CT of abdomen before operation-only certain proof for diagnosis. We do not have recurrences and none of our patients need analgetics more than two weeks after surgery. Laparoscopic incisional hernia surgery is not performed routine in our hospital yet. Conclusion Lumbar incisional hernias should be treated with sublay (preperitoneal placing of MESH) whenever is possible. CT evaluation before and after surgery is always usefull for large hernias, with big level of recommendence.