Minimally invasive transabdominal preperitoneal repair of incisional lumbar hernia

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. Anatomical location makes challenging diagnosis and repair. Individual approach for every patient is a 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, 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 incisional left site lumbar hernia, 10cm defect diameter with descending colon and spleen as a 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 optimal view in 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. Keywords: Incisional lumbar hernia, Preperitoneal repair, Hernia with rare location