Endoscopic retroperitoneal repair of superior lumbar hernia (Grynfeltt hernia) using self-fixating mesh to prevent nerve injury: a case report

Abstract

Background: The primary superior lumbar hernia, also called the Grynfeltt Hernia, is a rare entity; hence, a standard surgical repair method has not been established. It is important for this repair procedure not only to prevent recurrence by placing an adequate size of mesh but also to avoid nerve injury. The endoscopic retroperitoneal approach is considered a useful technique for this procedure, requiring no mobilization of the colon and providing good visibility of the surrounding nerves. A self-fixating mesh does not require a traumatic fixation, which is considered advantageous for nerve preservation.

Case presentation: A 72-year-old woman, complaining of left lumbar swelling, was diagnosed with a primary left superior lumbar hernia and underwent endoscopic retroperitoneal hernia repair. With the patient in the right lateral decubitus position, five small ports were inserted, and the retroperitoneal space was dissected. The 2.0 × 1.0-cm hernial orifice was found, and the 12th subcostal nerve above the hernial orifice and the iliohypogastric and the ilioinguinal nerves below the hernial orifice were identified. A 15 × 10-cm self-fixating mesh was placed in the retroperitoneal space without mesh tacking. The postoperative course was uneventful, and the patient was discharged on the first postoperative day. Two years after surgery, there was no sign of recurrence, and chronic pain and neuropathic symptoms were absent.

Conclusions: Endoscopic retroperitoneal repair of primary superior lumbar hernia using a self-fixating mesh seems to be useful for nerve preservation.

Keywords: Laparoscopic retroperitoneal repair; Self-fixating mesh; Superior lumbar hernia.

Fig. 1

Abdominal computed tomography. Abdominal computed tomography revealed the left superior lumber hernia (arrow). The size of the fascial defect was 2.0 × 1.0 cm

Fig. 2

Schema of endoscopic ports placement. Patient was placed in the right lateral decubitus position. A 2-cm skin incision was made 2 cm caudal to the 11th rib. a Superior lumbar hernia bulge visible from the body surface. b 11th rib. c Iliac crest

Fig. 3

Intraoperative view after dissection of the retroperitoneal space. Intraoperative view indicates a hernial orifice (arrowheads). 12th SN: 12th subcostal nerve; IHN: iliohypogastric nerve; IIN: ilioinguinal nerve

Fig. 4

Intraoperative view after mesh placement. A self-fixating mesh of 15 × 10 cm was placed without traumatic mesh fixation

Fig. 5

Postoperative abdominal computed tomography. Two years after the surgery, there was no sign of recurrence