Laparoscopic Lumbar Hernia Repair

Edward D Auyang, MD MS, Andrew S Wright, MD. Department of Surgery, University of Washington

 

Introduction:
Lumbar hernias are rare clinical entities with less than 400 reported in the literature. They were first described by deGarangeor in 1731. Petit later characterized the inferior lumbar triangle hernia in 1783 and Grynfeltt the superior lumbar triangle hernia in 1866. 80% of lumbar hernias are acquired due to increased intra-abdominal pressure, surgical incisions, or trauma. The remaining 20% are congenital. There is a 25% risk of incarceration and >8% chance of strangulation associated with lumbar hernias. Therefore, repair is recommended for symptomatic hernias. Laparoscopic repair was first described in 1997. The laparoscopic approach has the advantage over an open approach due to better hernia defect visualization and more accurate hernia size measurement. An adequate underlay mesh can then be placed. This video demonstrates a laparoscopic repair of a left-sided lumbar hernia (combined Petit and Grynfeltt) in a 47 year old male patient with a previous history of a motor vehicle accident.

Methods:
The patient is placed in a 45 degree semi-lateral position. Insufflation is obtained using a Veress needle at a left peri-umbilical location. An 11-mm port is placed at this location and a 10-mm 30-degree angled laparoscope is used for visualization. Three additional working ports are placed for medial mobilization of the colon and kidney, reduction of the hernia, dissection of the hernia margins, and placement of an underlay mesh. A coated polyester mesh is placed with a 4-cm overlap in each direction. Trans-abdominal sutures are placed to anchor the mesh and laparoscopic tacks are used to circumferentially affix the mesh.

Results:
The procedure was completed in 125 minutes with minimal blood loss and no intraoperative or postoperative complications.

Conclusion:
Laparoscopic lumbar hernia repair is a feasible operation that provides excellent visualization and measurement of the hernia defect, and allows for application of an underlay mesh with adequate overlap.
 

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Session Number: VidTV2 – Video Channel Rotation Day 2
Program Number: V099