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Case Reports
. 2020:67:120-122.
doi: 10.1016/j.ijscr.2020.01.034. Epub 2020 Feb 6.

Single-incision retroperitoneal laparoscopic repair of superior lumbar hernia using self-fixating ProGrip mesh: A case report

Yujiro Nakahara  1 , Masaki Wakasugi  2 , Satoshi Nagaoka  3 , Satoshi Oshima  3
Affiliations
Case Reports

Single-incision retroperitoneal laparoscopic repair of superior lumbar hernia using self-fixating ProGrip mesh: A case report

Yujiro Nakahara et al. Int J Surg Case Rep. 2020.

Abstract

Introduction: Lumbar hernia is rare and represents less than 1-2% of all abdominal hernias. There are mainly two types of lumbar hernia: superior lumbar hernia and inferior lumbar hernia.

Case presentation: A 65-year-old woman was admitted complaining of a mass in her left lumbar area. Under a diagnosis of superior lumbar hernia, single-incision laparoscopic retroperitoneal repair was performed. A single, 2-cm-long incision was made and the retroperitoneal space was dissected gradually. The hernia orifice was recognized and hernia sac was slipped from the hernia orifice. The collateral branch of subcostal nerve and iliohypogastric nerve were recognized. Laparoscopic self-fixating mesh was placed to cover the hernia orifice without mesh fixation. The patient remained well with no signs of recurrence.

Discussion: In laparoscopic lumbar hernia repair, it is important to be careful not to damage subcostal nerve and iliohypogastric nerve. Self-fixating mesh without fixation is useful due to the prevention from nerve injury. To our best knowledge, this is the first report of single-incision laparoscopic repair for superior lumbar hernia. Single-incision laparoscopic surgery could provide good cosmetic results with minimal incision.

Conclusion: We successfully performed single-incision retroperitoneal laparoscopic repair of superior lumbar hernia using self-fixating mesh.

Keywords: Laparoscopic self-fixating mesh; Single-incision retroperitoneal laparoscopic repair; Superior lumbar hernia.

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Figures

Fig. 1
Fig. 1
Computed tomography revealed the left superior lumbar hernia (white arrow). The size of hernia orifice was 20 × 14 mm.
Fig. 2
Fig. 2
Patient positioned in the right lateral decubitus. Incision was made 1 cm ventral from the middle point between the 12th rib and superior anterior iliac spine on the middle axillary line. a: Superior lumbar hernia. b: The 12th rib line. c: Superior anterior iliac spine. d: The middle point between the 12th rib and superior anterior iliac spine on the middle axillary line. e: Incision line.
Fig. 3
Fig. 3
The retroperitoneal space was dissected. The hernia orifice, the collateral branch of subcostal nerve and iliohypogastric nerve were recognized. a: The hernia orifice. b: The collateral branch of subcostal nerve. c: Iliohypogastric nerve.
Fig. 4
Fig. 4
ProGrip™ laparoscopic self-fixating mesh was placed to cover the hernia orifice without mesh fixation.
See this image and copyright information in PMC

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