Retroperitoneal totally endoscopic prosthetic repair of primary lumbar hernia

作者：Li, B.; Yu, J.; Qin, C.; Gong, D.; Nie, X.; Li, G.^*

来源：Hernia, 2021, 25(6): 1629-1634.

DOI：10.1007/s10029-020-02334-z

• Retroperitoneoscopic surgery
• Retroperitoneal TEP repair
• Lumbar hernia
• Grynfeltt hernia

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 cm(2) (range 4-12 cm(2)), and the mean mesh area was 144.6 cm(2) (range 130-180 cm(2)). 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.

• 单位
  上海交通大学; 南方医科大学