Retroperitoneal totally endoscopic prosthetic repair of primary lumbar hernia
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ORIGINAL ARTICLE
Retroperitoneal totally endoscopic prosthetic repair of primary lumbar hernia B. Li1 · J. Yu2 · C. Qin3 · D. Gong1 · X. Nie1 · G. Li4 Received: 11 July 2020 / Accepted: 2 November 2020 © Springer-Verlag France SAS, part of Springer Nature 2020
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 Retroperitoneoscopic surgery · Retroperitoneal TEP repair · Lumbar hernia · Grynfeltt hernia
Introduction
B. Li, J. Yu and C. Qin contributed equally to this work. * G. Li [email protected] 1
Department of General Surgery, Affiliated Hexian Memorial Hospital of Southern Medical University, Guangzhou 511400, China
2
Department of General Surgery, Shanghai Ninth People’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 201999, China
3
Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100043, China
4
Department of General Surgery, Nanfang Hospital, Southern Medical University, 1838 N Guangzhou Ave, Guangzhou 510515, China
A primary lumbar hernia is a rare entity, and only around 300 cases have been reported in the literature in the past 300 years [1]. A general surgeon will most likely have the opportunity to repair only one case in his or her lifetime [2]. A primary lumbar hernia is a defect in the lumbar region, which is bounded by the 12th rib above, the iliac crest be
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