Laparoscopic repairviathe transabdominal preperitoneal procedure for bilateral lumbar hernia: Three cases report and review of literature

Abstract

A lumbar hernia is a rare entity, and a bilateral lumbar hernia is much rarer. From May 2015 to October 2017, we treated only three patients with bilateral lumbar hernias. One patient came to the hospital presenting with right-sided abdominal pain, and the other two patients presented with bilateral lumbar masses. The previous bilateral lumbar hernia reported in the literature was repaired by open surgery. The laparoscopic approach via the transabdominal preperitoneal (TAPP) procedure with the self-gripping Parietex ProGrip™ mesh was performed at our center. The laparoscopic repair was conducted by a skilled hernia surgeon, and was successfully performed in the three patients. The patients resumed a semi-liquid diet and had no activity restriction after six hours following the operation. No antibiotics were used after the surgery. The operative times of the three patients were 120 min, 85 min, and 130 min. The blood loss volumes of the three patients were 20 mL, 5 mL, and 5 mL. The visual analogue scale pain scores of the three patients were 1, 2, and 2 on postoperative day 1, and were 1, 2, and 1 on postoperative day 3. No perioperative complications, such as bulge, wound infection and hematoma, occurred after the surgery. All of the patients were discharged on the third day after the operation. There was no chronic pain and no hernia recurrence during the follow-up. This study showed that the laparoscopic TAPP approach with the self-gripping mesh is safe and feasible, and can be considered an alternative method for the treatment of bilateral lumbar hernias.

Bilateral Fat Containing Lumbar Hernia: A Case Report and Literature Review

“…A painless lumbar swelling is the most common complaint. Less commonly, patients will be presented with backache, intercostal neuralgia, bowel obstruction, hydronephrosis, and hydroureter [3,10,11]. Our patient presented with left upper abdominal pain.…”

“…While increased intra-abdominal pressure is considered a high-risk factor for all hernias, our patient reported heavy object lifting and had chronic obstructive pulmonary disease. A lumbar hernia may contain different intraperitoneal organs or extra peritoneal fat [3,7,9].…”

“…Lumbar hernia is characterized by being reducible and more prominent with increased intra-abdominal pressure such as changing the position to sitting or standing. A contrast-enhanced computed tomography (CT) scan is the gold standard and essential examination for confirming the diagnosis of lumbar hernia as it shows protrusion and hernia sac through the musculature [1,3].…”

“…The laparoscopic approach is further divided into transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) approaches. Compared to TEP, TAPP is more commonly described as it is easier to perform and yields good results [3]. Despite the best of surgical repair, failures have been reported.…”

“…Mostly lumbar hernias are misdiagnosed with subcutaneous lipoma. To date, still, there is no consensus on the best way for managing lumbar hernias [2,3,5,6].…”