INTRODUCTION: Lumbar hernias are rare defects of the posterolateral abdominal wall. Surgical repair of lumbar hernias is challenging because they are bounded inferiorly by the iliac bone, which makes adequate mesh fixation difficult. We demonstrate a method of a laparoscopic lumbar hernia repair utilizing bone anchor fixation at the inferior border.
METHODS: The patient is a 37-year old male with a history of motor vehicle collision who presented with a large left lumbar hernia and nonspecific abdominal pain. The patient had a Petit-type hernia, bordered by the external oblique muscle, the latissimus dorsi and the iliac crest. We opted to perform a laparoscopic mesh repair. Two Mitek GII QuickAnchor sutures were placed in the anterior superior iliac crest to provide inferior fixation of the mesh, with sufficient overlap of the mesh to prevent recurrence. The remainder of the mesh is fixed with standard laparoscopic tacks and transfascial sutures.
RESULTS: The patient did well postoperatively and left the hospital on the first post-operative day. He has had no signs of recurrence at followup.
CONCLUSIONS: The anatomic features of lumbar hernias creates several challenges. A number of surgical approaches have been described, including laparoscopic and open methods, as well as intraperitoneal and preperitoneal approaches and the use of flaps to cover the defects. However, limited fixation points for the mesh can lead to high recurrence rates. We demonstrated a method utilizing bone anchor fixation in a laparoscopic approach to overcome the challenge of inferior fixation. This provides a secure repair with good coverage of the defect, while maintaining the benefits of the minimally-invasive approach.
Session: Podium Video Presentation
Program Number: V015