Laparoscopic Transabdominal Preperitoneal Repair of Lumbar Hernia

Abstract

Lumbar hernias are rare hernias arising from lateral side of abdominal wall. It was frst described by Barbette in 1672, since then there are about 300 cases published in the literature. Among all abdominal hernias there are only 1-2% of lumbar hernia. We herein report a case of right lumbar hernia of a 59 years male. The patient presented to us with pain and swelling in right lumbar region for three years which increases in size on coughing, straining and standing. He didn’t give history of any trauma or prior surgery in the site of swelling. On examination revealed good general condition, a swelling of around 10 cm x 8 cm in right
lumbar region. An abdominal CT scan revealed a defect of size 8 cm in right lumbar region at the level of superior lumbar triangle of grynfeltt with a hernia sac containing bowel.  The case was planned for laparoscopic repair of hernia through transabdominal preperitoneal approach. Preperitoneal space was created in the region of hernia by opening fap of peritoneum from 12th rib to the iliac crest, six transfascial suture was taken using prolene no. 1 to oppose
defect then 20 cm x 25 cm mesh was placed over hernial orifce. Laparoscopic transabdominal preperitoneal repair of lumbar hernia is cost efective and more
efcient than other laparoscopic repair and open repair. Transfascial fxation provide immediate sense of strength to abdominal wall and decrease size of mesh requirement.