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. 2021 Dec;25(6):1629-1634.
doi: 10.1007/s10029-020-02334-z. Epub 2020 Nov 18.

Retroperitoneal totally endoscopic prosthetic repair of primary lumbar hernia

B Li #  1 , J Yu #  2 , C Qin #  3 , D Gong  1 , X Nie  1 , G Li  4
Affiliations

Retroperitoneal totally endoscopic prosthetic repair of primary lumbar hernia

B Li et al. Hernia. 2021 Dec.

Abstract

Purpose: A primary lumbar hernia is a rare entity that requires surgical management, but the preferred technique has not been established. We herein describe a standardized and reproducible retroperitoneal totally endoscopic prosthetic (TEP) repair technique for primary lumbar hernias.

Methods: Ten adult patients with primary lumbar hernias underwent retroperitoneal TEP repair from February 2019 to July 2020. A sufficient retroperitoneal space was established to accommodate a non-coated polypropylene mesh to reinforce the weakened flank area, and hernia content reduction and defect closure were then performed. The patients' clinical data were prospectively collected and analyzed.

Results: Nine patients had a primary superior lumbar hernia and one patient had a primary diffuse lumbar hernia. All operations were successfully performed without serious intraoperative complications. The mean defect area was 6.4 ± 2.8 cm2 (range 4-12 cm2), and the mean mesh area was 144.6 cm2 (range 130-180 cm2). The average operative time (skin to skin) was 49.0 ± 5.7 min (range 40-60 min), and intraoperative bleeding was minimal. The mean visual analog pain scale score at rest on the first postoperative day was 2.2 (range 2-3). The average length of postoperative stay was 1.5 days (range 1-2 days). No serious postoperative complications occurred. No recurrence, chronic pain, or mesh infection occurred during a mean follow-up period of 7.5 months.

Conclusions: The retroperitoneal TEP repair for primary lumbar hernias is safe, efficient, and reproducible. Anti-adhesive coated meshes and fixation tackers are not required, making this a cost-effective procedure that is worthy of recommendation.

Keywords: Grynfeltt hernia; Lumbar hernia; Retroperitoneal TEP repair; Retroperitoneoscopic surgery.

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