Lateral Abdominal Wall Hernia Research Articles

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.

Lateral abdominal wall hernia: A surgeon’s dilemma

Lateral abdominal wall hernia: A surgeon’s dilemma

Siblings with profound connective tissue disease: First report of biallelic TGFBR1-related Loeys-Dietz syndrome.

Heterozygous missense variants in TGFBR1, encoding one subunit of the transforming growth factor-beta receptor, are a well-established cause of Loeys-Dietz syndrome (LDS)-an autosomal dominant disorder with variable phenotypic expression. Patients with LDS have compromised connective tissues that can result in life-threatening arterial aneurysms, craniosynostosis, characteristic craniofacial and skeletal anomalies, skin translucency, and abnormal wound healing. We report a full sibship with a biallelic type of TGFBR1-related disease. Each born at 38 weeks had aortic root dilation, congenital diaphragmatic hernia (CDH), skin translucency, and profound joint laxity at birth. Both had progressive dilation of the aorta and recurrence of a diaphragmatic defect after plication early in infancy. Patient 1 died at 66 days of age and Patient 2 is alive at 4 years and 4 months of age with multiple morbidities including cystic lung disease complicated by recurrent pneumothoraces and ventilator dependence, craniosynostosis, cervical spine instability, progressive dilation of the aorta, worsening pectus excavatum, large lateral abdominal wall hernia, and diffuse aortic ectasia. Fibroblasts cultured from Patient 2 showed decreased TGF-β responsiveness when compared to control fibroblasts, consistent with previous observations in cells from individuals with autosomal dominant LDS. Whole genome copy number evaluation and sequencing for both patients including their parents as reference revealed compound heterozygous variants of uncertain clinical significance in exon 2 of TGFBR1 (c.239G>A; p.Arg80Gln paternal and c.313C>G; p.His105Asp maternal) in both siblings in trans. Each parent with their respective variant has no apparent medical issues and specifically no LDS characteristics. Neither of these variants have been previously reported. Thousands of patients have been diagnosed with LDS-an established autosomal dominant disease. These siblings represent the first reports of biallelic TGFBR1-related LDS and expand the differential diagnosis of CDH.

Open Retromuscular Lateral Abdominal Wall Hernia Repair: Algorithmic Approach and Long-Term Outcomes at a Single Center.

Lateral abdominal wall hernias are relatively rare and present unique challenges to repair. Our group has developed an algorithm for repair based on several anatomic characteristics identified on preoperative imaging. Herein, we report our algorithm and outcomes of a large series of open retromuscular lateral abdominal wall hernia repairs. Open retromuscular lateral abdominal wall hernia repairs performed at our institution from August 2014 through April 2021 were identified in the Abdominal Core Health Quality Collaborative. Hernia characteristics, etiology, operative techniques, postoperative outcomes, and long-term patient-reported outcomes were extracted from the Abdominal Core Health Quality Collaborative database, chart review, and telephone follow-up. Of 464 patients who underwent hernia repair, 121 with isolated lateral abdominal wall hernias (L1-4) and mean follow-up of 34 ± 24 months had a clinical recurrence rate of 0.9% (n = 1) and bulge rate of 37% (n = 42). The median Hernia-Related Quality of Life Survey and PROMIS pain intensity scores improved 37 and 9 points, respectively. Another 343 patients with lateral (L1-4) and midline (M1-5) abdominal wall hernias and mean follow-up of 29 ± 21 months had a clinical recurrence rate of 6% (n = 20) and bulge rate of 35% (n = 117). The median Hernia-Related Quality of Life Survey and PROMIS pain intensity scores improved by 43 and 16 points, respectively. We present an algorithm for open retromuscular lateral abdominal wall hernia repair with relatively low anatomic recurrence rates and substantial improvement in patient-reported quality of life and pain. Notably, postoperative bulging is commonly reported by patients, likely due to underlying denervation injuries from the original incision.

A computed tomography study investigating the effects of botulinum toxin injections prior to complex abdominal wall reconstruction

ObjectiveTo explore how intramuscular injection of botulinum toxin A (BTA) affects the lateral abdominal wall (LAW) musculature, abdominal- and hernia dimensions, and muscle structure on computed tomography (CT) in patients scheduled for complex abdominal wall reconstruction (CAWR).MethodsRetrospective analysis of prospectively registered patients who received bilateral intramuscular BTA injections into all three muscles of the LAW. Only patients for which a CT was available before and 3–6 weeks after BTA treatment prior to surgery were analyzed.ResultsFifty-two patients were analyzed. Median hernia width in all patients decreased with 0.4 cm (IQR − 2.1;0.6) (p = 0.023). Median intra-abdominal transverse diameter increased with 0.9 cm (IQR − 0.2;3.3) (p = 0.001) and the intra-abdominal anterior–posterior diameter decreased with 0.5 cm (IQR − 1.3;0.5) (p = 0.017), making the abdomen more oval. Median LAW muscle length increased with 0.9 cm (IQR 0.0;2.4) per side (p < 0.001), muscle thickness decreased with 0.5 cm (IQR − 0.8;− 0.2) (− 25.0%) per side (p < 0.001), and muscle mass decreased with 3.9 cm2 (IQR − 6.4;-1.5) (− 15.8%) per side (p < 0.001). Median HU of the psoas muscles (density) increased with 4.8 HU (IQR 0.4;9.7) (10.3%) per side (p < 0.001). Effects of BTA were more pronounced in patients with a loss of domain (LoD) ≥ 20%.ConclusionsThe main effect of BTA injections is elongation and thinning of the LAW muscles, more than a decrease in hernia width. Concomitantly, the abdomen becomes more oval. An increase of psoas muscles density is seen, associated with offloading of the LAW muscles. Patients with large LoD have a proportionally higher effect of BTA.

MIS retromuscular repair of lateral incisional hernia: technological deliberations and short-term outcome.

Lateral abdominal wall hernias (LAWH) constitute about 1-4% of hernia surgical procedures. They represent a unique surgical challenge on account of their potential for anatomical complexity and consequent operative technical demand. Furthermore, LAWH repairs are currently not standardized, and remain contentious, despite a variety of approaches. These repairs are attendant with not insignificant morbidity and recurrence rates. We profile here our endoscopic and hybrid surgical approach to the management of LAWH and early therapeutic outcomes. A retrospective review of our hernia clinical database between March 2018 and December 2020 was performed to extract all LAWH (with and without an associated midline component) patients, who underwent an enhanced-view totally extra peritoneal (eTEP) hernia repair with a transversus abdominis release (TAR), or a hybrid repair. Initial outcome data (6-month follow-up) is profiled here. The primary outcome measures were hernia recurrence and hernia-site bulging. The secondary measures were surgical site occurrence (SSO) and hernia-related quality of life (QoL). A total of 33 LAWH patients underwent an eTEP TAR or hybrid hernia repair. 11 patients had an associated midline defect and 12 were recurrent hernias. The mean hernia defect area was 84.2 ± 49cm2 and mean mesh size was 859.6 ± 263cm2. There was no hernia recurrence at initial follow-up of 24months. The SSO rate was 12%. The CCS QoL scores were 34.6 ± 2 pre-operatively, and improved to 27.2 ± 4 at 6months. Our endoscopic and hybrid technique is a safe, reproducible, and technically promising approach for the repair of LAWH. Thorough knowledge of the surgical anatomy of the lateral abdominal wall and advanced endosurgical skills are imperative for good outcomes. We await the long-term results of our LAWH cohort to confirm the findings.

Spigelian-like hernia with cryptorchidism and tibial hemimelia

We describe a case of an unusual lateral congenital abdominal wall hernia. This male patient was born with a constellation of anomalies including a Spigelian-like left lower quadrant abdominal wall hernia, right tibial hemimelia, left hip dysplasia with dislocation, cleft palate and cryptorchidism. At three months of age, the patient underwent a diagnostic laparoscopy, right inguinal hernia repair, left lower quadrant abdominal wall hernia repair, and bilateral orchiopexy to manage these defects.

Transversus Abdominis Release Versus Anterior Component Separation in Ventral Abdominal Hernia - A Prospective Comparative Study

Ventral abdominal hernia (VAH) repair is considered a surgical challenge especially hernias with large defect size and loss of domain (1-3). The incidence of recurrence after VAH repair ranges from 18.1% in primary VAH to 30.6% in secondary VAH (incisional hernia) (4). The principle of any hernia repair is to achieve a tension free repair with re-enforcement by mesh to decrease the incidence of recurrence (5). Many techniques had been studied and evaluated to address the problem of complex VAH with large defects and loss domain (1,6). In 1973, Rives et al. described their technique of retro rectus space dissection for incisional hernia (IH) repair allowing medial mobilization of myofascial flap and sub-lay mesh insertion (7, 8). But this technique has limitation in cases of large VAH as it doesn’t allow major myofascial advancement due to lateral limitation of linea semilunaris (LS) (9). In 1990, Ramirez et al. at described their technique of open anterior component separation (ACS) (10). In this technique, the external oblique aponeurosis is separated from internal oblique lateral to LS to achieve more medial mobilization of myofascial flap (9). ACS was successfully utilized in cases of large VAH, but the technique had its drawbacks. ACS was found to be associated with high rates of wound complications (seroma, wound infection, and flap necrosis) due to excess subcutaneous dissection with the possibility of lateral abdominal wall hernia at area of external oblique incision. The recurrence rate after ACS ranges from 9-18% (4). In 2012, Novitsky et al. were the first to describe the technique of posterior component separation and transversus abdominis release (PCS-TAR). The technique involved retro rectus space dissection reaching the LS, then an incision is made at posterior rectus sheath to access the space between internal oblique and transversus abdominis muscles. Dissection is carried on in this space until reaching psoas muscle laterally. This technique has the advantage of allowing maximum medial myofascial mobilization without major subcutaneous dissection. In addition, the technique allows for sub-lay mesh placement (11). All these different component separation techniques aim to reestablish a functional abdominal wall through autologous tissue repair by separating between myofascial layers of anterior abdominal wall (AAW). This allows medial mobilization of myofascial flap to obliterate large size defects (12-14). Due to the relative novelty of these techniques, a knowledge gap still persists regarding which CS technique is suitable to different types of VAH. The aim of our study is to compare the outcomes of TAR with ACS as regard short term postoperative complication and recurrence rate.

[Management of lateral abdominal wall hernias].

Lateral abdominal wall hernias are rare and inconsistently defined, which is why the use of the European Hernia Society classification makes sense, not least for the purpose of comparing the quality of surgical results. Adistinction must be made between true fascial defects and denervation atrophy. Based on the available literature, there is generally alow level of evidence with no consensus on the best operative strategy. The proximity to bony structures and the complex anatomy of the three-layer abdominal wall make the technical treatment of lateral hernias difficult. The surgical variations include laparoendoscopic, robotic, minimally invasive, open or hybrid approaches with different mesh positions in relation to the layers of the abdominal wall. The extensive preperitoneal mesh reinforcement open, transabdominal peritoneal (TAPP) laparoscopic repair or total extraperitoneal (TEP) endoscopic repair has met with the greatest approval. The extent of the required medial mesh overlap is determined by the distance between the medial defect boundary and the lateral edge of the straight rectus abdominus muscles. The medially directed preperitoneal and retroperitoneal dissection can be extended into the homolateral retrorectus compartment by laterally incising the posterior rectus sheath or by crossing the midline behind the intact linea alba into the contralateral retrorectus compartment. The intraperitoneal onlay mesh (IPOM) technique is asuitable procedure only for smaller defects with possible defect closure but it is also important as an exit strategy in the case of adefective peritoneum. Individualized prehabilitative and preconditioning measures are just as important as the assessment of preoperative anamnestic and clinical findings and risks with radiographic cross-sectional imaging diagnostics.

Totally endoscopic sublay (TES) repair for lateral abdominal wall hernias: technique and first results.

The optimal surgical treatment for lateral hernias of the abdominal wall remains unclear. The presented prospective study assesses for the first time in detail the clinical value of a totally endoscopic sublay (TES) technique for the repair of these hernias. Twenty-four consecutive patients with a lateral abdominal wall hernia underwent TES repair. This technique is naturally combined with a transversus abdominis release maneuver to create a sufficient retromuscular/preperitoneal space that can accommodate, if necessary, a giant prosthetic mesh. The operations were successful in all but one patient who required open conversion because of dense intestinal adhesion. The mean defect width was 6.7 ± 3.9cm. The mean defect area was 78.0 ± 102.4 cm2 (range 4-500 cm2). The mean mesh size used was 330.2 ± 165.4 cm2 (range 108-900 cm2). The mean operative time was 170.2 ± 73.8min (range, 60-360min). The mean visual analog scale score for pain at rest on the first day was 2.5 (range 1-4). The average postoperative stay was 3.4days (range 2-7days). No serious complications (Dindo-Clavien Grade 2-4) were seen within a mean follow-up period of 13.3months. A totally endoscopic technique (TES) for the treatment of lateral hernias is described. The technique revealed to be reliable, safe and cost-effective. The first results are promising, but larger studies with longer follow-up periods are recommended to determine the real clinical value.

An unusual presentation and management of incarcerated Richter’s type of Spigelian hernia: a rare case report and review of literature

Spigelian hernias (SH) are one of the rare forms of ventral abdominal hernias which constitutes about 1-2%. SH occurs through the defect in the anterior abdominal wall adjacent to the semilunar line which occurs in the lower abdomen where the posterior sheath is deficient. The usual presentation of SH is a painful mass in mid abdomen above anterior superior iliac spine (ASIS). The diagnosis is made by means of ultrasound and computed tomography (CT). We report 69 years old female who is a known case of Parkinson’s disease and on medication presented with 2 days of sudden-onset right iliac fossa (RIF) associated with intermittent nausea, vomiting and also abdominal distension. O/E: Abdomen soft, tenderness in RIF with swelling above the line of ASIS. With the diagnosis of lateral abdominal wall hernia we took a CT scan that shows obstructed SH. Immediately she underwent surgery, intra-operative picture shows intraparietal hernia with Richter’s type and viable bowel. Abdominal wall is very weak and flimsy with no proper differentiation between the layers. Preperitoneal mesh repair was performed. The post-operative (post op) period was uneventful. Till now there was only 6 type of Richter’s SH reported. In this article we discuss a brief knowledge of SH and the management part of SH. We hope that this article will benefit among the surgeons in treating with SH. 

Management of lateral abdominal hernias.

Lateral abdominal wall hernias are rare defects but, due to their location, repair is difficult, and recurrence is common. Few studies exist to support a standard protocol for repair of these lateral hernias. We hypothesized that anchoring our repair to fixed bony structures would reduce recurrence rates. A retrospective review of all patients who underwent lateral hernia repair at our institution was performed. Eight cases (seven flank and one thoracoabdominal) were reviewed. The median defect size was 105 cm2 (range 36-625 cm2). The median operative time was 185min (range 133-282min). There were no major complications. One patient who was repaired without mesh attachment to bony landmarks developed a recurrence at ten months and subsequently underwent reoperation. Patients with mesh secured to bony landmarks were recurrence free at a median follow-up of 171days. Lateral hernias present a greater challenge due to their anatomic location. An open technique with mesh fixation to bony structures is a promising solution to this complex problem.

A Large Single-Center ‘Experience of Open Lateral Abdominal Wall Hernia Repairs

Lateral abdominal wall hernias may occur after a variety of procedures, including anterior spine exposure, urologic procedures, ostomy closures, or after trauma. Anatomically, these hernias are challenging and require a complete understanding of abdominal wall, interparietal and retroperitoneal, anatomy for successful repair. Mesh placement requires extensive dissection of often unfamiliar planes, and its fixation is difficult. We report our experience with open mesh repair of lateral abdominal wall hernias. A retrospective review of a prospectively maintained database was performed to identify patients with a classification of lateral abdominal wall hernia who underwent an open repair. A total of 61 patients underwent open lateral hernia repairs. Mean patient age was 58 years (range 25-78), with a mean body mass index of 32 kg/m(2) (range 19.0-59.1). According to the European Hernia Society classification, defects were located subcostal (L1, 14 patients), flank (L2, 33 patients), iliac (L3, 11 patients), and lumber (L4, 3 patients). Mean defect size was 78.6 cm(2), with a mean greatest single dimension of 9.2 cm (range 2-25 cm). Retromuscular or interparietal repair was performed in 50.8 per cent, preperitoneal in 41.0 per cent, intraperitoneal in 6.6 per cent, and onlay in 1.6 per cent. The rate of surgical site occurrence was 49.2 per cent, primarily seroma and surgical site infection rate was 13.1 per cent. With a mean follow-up of 15.4 months, seven patients (11.5%) have documented recurrence. Synthetic mesh reconstruction of lateral wall hernias is challenging. Our experience demonstrates the safety and success of repair using synthetic mesh primarily in the retromuscular, interparietal, or preperitoneal planes.

Mesh repair of a large traumatic lateral abdominal wall hernia in an 8-day-old foal

Summary An 8-day-old French trotter colt was admitted with a traumatic lateral abdominal wall hernia with reducible intestinal content. A 15 cm long full thickness tear was identified in both the internal abdominal oblique and transverse abdominal muscles. This case report describes the surgical repair of the hernia using a polypropylene mesh.

An Evidence-Based Model for the Successful Treatment of Flank and Lateral Abdominal Wall Hernias.

Lateral abdominal wall defects are a significant contributor to patient morbidity and mortality in the United States. Reconstruction involving flank hernias and bulges is relatively scarce in the literature despite its serious consequences. The authors aim to identify an objective approach for the evaluation and successful repair of defects of the lateral abdominal wall. A retrospective analysis was carried out on patients presenting for open repair of a lateral wall defect performed by a single surgeon. Over a 5-year period, there were 29 consecutive patients with a mean follow-up period of 21.2 months. Patient demographics including body mass index, number of hernia defects, number of previous repairs/abdominal operations, defect size, operative time, blood loss, and complications (e.g., recurrence/bulge, seroma, hematoma, wound infection, persistent pain, skin breakdown, and fascial dehiscence) were collected. Patients who underwent flank hernia repairs using an inlay/underlay nonbridged technique with the use of acellular dermal matrix had low recurrence and overall complication rates. Only one patient (3.4 percent) had a recurrence at follow-up, and another patient (3.4 percent) had developed a bulge. The authors' data indicate successful results when their technique is applied. Proper patient selection is essential, along with a thorough understanding of anatomy and techniques for successful reconstruction. The authors recommend using an inlay (preferred) or underlay repair with acellular dermal matrix to reinforce the surrounding musculofascial closure. This technique, in conjunction with the authors' holistic abdominal wall reconstruction protocol, has optimized outcomes and identified a successful multidisciplinary strategy for the reconstruction of lateral wall defects. Therapeutic, IV.

INVESTIGACIÓN HISTÓRICA DE LAS HERNIAS LATERALES DE LA PARED ABDOMINAL

historical analysis of the lateral abdominal wall hernias Objective: To analyze the history of lateral abdominal wall hernias. method: Review of the literature. Critical analysis of articles, books and monographs published, using key words: “ventral, lateral or semilunar abdominal wall hernia”. results: Undocumented contributions, such as Mancke, Molliere, Reynier, Ferrand or Thevenot, among others are discovered. Casseri was the first surgeon to illustrate the semilunar line, before Spiegel. Mancke was the first surgeon to use the term lateral ventral hernia. Molliere was the first surgeon to use the term semilunar hernia (not Klinkosch). Thevenot was the first surgeon to use the term Spiegel hernia. conclusion: The story of the lateral hernias has errors and omissions of important authors. 1) semilunar line was known and illustrated first by Casseri, so we should call Spiegel-Casseri semilunar line; 2) Klinkosch was not the first to use the name of semilunar hernia, but Molliere, who defined them as a different group of ventral; 3) Mancke was first named as the lateral hernias, and Ferrand side who made the first thesis under that title, and 4) the contributions of Reignier and Thevenot, not mentioned in any treatise on surgery are discovered.

Controversias históricas de las hernias semilunares: Spiegel frente a Casseri, Klinkosch frente a Molliére

ObjectiveTo analyze the history of semilunar abdominal wall hernias. To verify who described the semilunar line first and who coined the term. MethodReview of the literature. Critical analysis of published articles, books and monographs using the key words: ventral, lateral or semilunar abdominal wall hernia. ResultsBiographical data are presented and the contributions of each author to such hernias are analyzed. Citations were corrected and adapted according to the international standards. Casseri was the first surgeon to illustrate the semilunar line before Spiegel described it. Molliére was the first surgeon to use the term “semilunar Spiegel hernia”, not Klinkosch. ConclusionThe story of the lateral hernias has errors and omissions of important authors. We highlight the contributions of Casseri and Molliére that have been forgotten in abdominal wall surgery texts.

Surgical repair of a congenital lateral abdominal wall hernia in a neonatal foal

SummaryA 16‐hour‐old Quarter Horse filly presented for evaluation of a soft mass in the right caudoventral lateral abdominal wall. Radiography and ultrasonography confirmed the presence of a nonreducible lateral abdominal wall hernia with small intestine located between the skin and body wall. The size of the defect itself could not be imaged and the filly was taken to surgery. A 4 cm vertical defect that appeared congenital was found in the transverse abdominal muscle and was repaired by primary apposition. This case report describes the repair and outcome of this unusual type of congenital hernia.

Radiological and clinical examination in the diagnosis of Spigelian hernias

IntroductionSpigelian hernia are rarely reported lateral abdominal wall hernias. Clinical diagnosis of a suspected hernia can be challenging owing to vague presenting symptoms and signs. This study aimed to investigate the accuracy of preoperative imaging and clinical examination in the diagnosis of Spigelian hernias.MethodsA retrospective analysis was performed of patients who presented to North Tyneside and Wansbeck General Hospitals between 1998 and 2010. All patients were assessed by a consultant general surgeon in the outpatient clinic or on the surgical admissions ward. Patients were included who presented with a history suggestive of a Spigelian hernia and a palpable lump or equivocal clinical examination. All patients proceeded to surgery, which was used as the reference standard.ResultsOverall, correlation with operative findings showed computed tomography (CT) to have a sensitivity of 100% and a positive predictive value (PPV) of 100%. Ultrasonography had a sensitivity of 90% and a PPV of 100%. Clinical assessment alone had a sensitivity of 100% and a PPV of 36%.ConclusionsThis study shows that ultrasonography and CT have a high sensitivity and PPV in relation to occult Spigelian hernias. When no obvious Spigelian hernia is present, patients should be evaluated with radiological investigation to establish a diagnosis. Owing to diagnostic uncertainty, a laparoscopic approach should be favoured.

Combination of autoplasty with autodermoplasty in the treatment of lateral abdominal hernias

Aim. To improve the outcomes of treatment in patients with lateral abdominal hernias by combining autoplastic methods with autodermoplasty. Methods. 42 case histories of patients with lateral abdominal wall hernias, operated in the first surgical department of the State Institution «Republican Clinical Hospital», Tiraspol city, from 2001 to 2011 were subjected to retrospective analysis. In all of the cases surgical treatment was performed. Combined methods of hernioplasty, which combine autoplasty with autodermoplasty, were applied. The authors’ personal patented method of hernioplasty was also used among others. Results. According to the classification of Chevrel-Rath (2000) 23 (54.7%) of the patients had inferolateral hernias, 5 (11.9%) patients - supra-lateral hernias, 8 (19%) patients - lumbar hernias, there were also 2 (4.8%) patients each with transrectal, pararectal and paracolostomy hernias. Despite their small number in the total amount of postoperative hernias (17.5%), 26 (65%) patients had large and giant lateral hernias, while recurrences were present in 7 (16.7%) cases. Treatment results were satisfactory. Complications and recurrence occurred in 1 (2.9%) patient each. Conclusion. The combination of autoplasty with autodermoplasty is an effective method of treatment for inferolateral, supra-lateral, pararectal, transrectal, paracolostomy and lateral hernias; during lumbar hernias autodermoplasty even with two autodermal grafts was not as effective, and therefore justified is the search for new methods of hernioplasty.