The primary lumbar hernia with multiple defects: a rare case

Lumbar hernia is a rare entity of abdominal wall hernia. Due to varied presentation it poses a challenge in diagnosis and management to attending surgeon. The requirement of preoperative imaging and clinical examination has indispensable role in the diagnosis and surgical (open or laparoscopic) approach is the only treatment option. We are presenting a case of 44 year old male, diagnosed as lumbar hernia with multiple defects and successfully managed by laparoscopic mesh hernioplasty. The primary lumbar hernia is a rare entity that a surgeon may encounter once in his lifetime making it an interesting surgical challenge. The adequate knowledge of preoperative imaging and anatomy are indispensable. With advances in minimally invasive surgery, it can be applied to patients with lumbar hernia and management requires a more tailored approach. This condition can be managed by laparoscopic approach successfully.

VP028 TAPP REPAIR FOR INCISIONAL LUMBAR HERNIA

Aim “Incisional hernias are very common and can present even after minimally invasive surgery for other pathologies. Laparoscopic ventral hernia repair first described by LeBlanc in 1992, gained great popularity, because of its known advantages over the open techniques. In the last decade because of increasing concerns about the future risks of using an intra-peritoneal mesh, several minimally invasive techniques using a mesh outside abdominal cavity have been described. We report the use of a TAPP technique.” Material and Methods “48 yo female patient, that underwent a laparoscopic right adrenalectomy, for myelolipoma, in 2015, with subsequent incisional lumbar hernia (L4W1) in the extraction incision.” Results “The patient was submitted to a laparoscopic TAPP repair in ambulatory surgery with extended recovery. The hernia defect was closed with a barbed suture and it was used a 15x15cm medium weight polypropylene mesh without traumatic fixation. For pain control it was done a TAP block guided by laparoscopy. The duration of surgery was 90 minutes. The patient had no complications. No recurrence on follow-up (4 months).” Conclusions “New minimally invasive procedures for the repair of incisional hernias avoid the intraperitoneal mesh position and maintain all the advantages of the minimally invasive approach. Some of these techniques may be complex and have a long learning curve. TAPP seems reproducible and a good option if a good extra-peritoneal dissection is possible. Larger series are needed, to accurately compare these new techniques with IPOM, open sublay and to select the best technique for each patient.”

OV14 POSTERIOR COMPONENT SEPARATION FOR A GIANT LUMBAR HERNIA IN A KIDNEY TRANSPLANT PATIENT

Aim Posterior component separation with transversus abdominis release (PCS-TAR) represents a good option for challenging complex ventral hernia repairs. We present a case of PCS-TAR for a giant lumbar hernia in a patient with a transplanted kidney. Material and Methods The patient is a 46 years old man with a Charlson Comorbidity Index of 2 and a BMI of 27.5 kg/m2 who underwent a kidney transplant in 2005 and a subsequent open repair with mesh implantation for an incisional hernia in 2007. Two years later, he experienced a hernia recurrence, but chose conservative management. In 2019, the patient complained of progressively worsening pain and bulky sensation. Due to the size and location of the defect and the massive relaxation of the muscle fibers, open repair with PCS-TAR was indicated. Results In 2019, the patient underwent right-sided PCS-TAR with retromuscular placement of one polyvinylidene fluoride (PVDF) mesh and one biosynthetic mesh. Duration of the procedure was 295 minutes. Two drains were placed, respectively in the subfascial and in the subcutaneous plane. Postoperative course required non-invasive ventilation for respiratory distress, but was otherwise uneventful and he was discharged on postoperative day 8. After 12 months, the patient showed no signs of recurrence. Conclusions PCS-TAR is a versatile technique for the repair of complex ventral hernias, with an acceptable rate of postoperative complications and good long-term outcomes.

Rare Cases of Bilateral Lumbar Hernia: Anaesthesia Concerns and Lessons Learnt

Bilateral lumbar hernias are rare. There is a paucity of literature regarding the anaesthesia techniques used and challenges faced. In the present era of minimally invasive surgery, laparoscopy has gained name and fame and is the modality of choice for hernia repairs. Methods: We report a series of 4 cases of bilateral lumbar hernia operated in our institute, using 4 different anaesthesia techniques over a period of 2 years and 9 months with the aim to focus on the varied anaesthetic techniques and the advantages and disadvantages of each. Results: General anaesthesia supplemented with epidural anaesthesia is recommended for laparoscopic repair, while in very high risk cases, combined segmental spinal- epidural anaesthesia may be a better option. Low dose segmental spinal provides commendable cardiovascular stability. It is a useful alternative in patients with multiple comorbidities, cardiac and respiratory diseases and aids early recovery and ambulation. Conclusion: Irrespective of the type of anaesthesia technique administered, patients’ safety and comfort should be of prime importance, while maintaining optimum haemodynamics and physiology.

Clinical, surgical characteristics and long-term outcomes of lumbar hernia

Background/Aim Lumbar hernia is caused by a defect in the abdominal wall. Due to its rarity, there is no established consensus on optimal treatment for lumbar hernia yet. Thus, we here investigated the clinical, surgical characteristics and outcomes of lumbar hernia by collecting 28 such patients from our hospital. Methods Patients diagnosed with lumbar hernia from our institution between April 2011 and August 2020 were retrospectively collected in this study. Demographics, clinical characteristics and surgical information were recorded. Results A consecutive series of 28 patients with lumbar hernia were retrospectively collected, including 13 males (46%) and 15 females (54%). The ages of the patients ranged from 5 to 79 years (median: 55 years), with a mean age of 55.6 ± 14.9 years. A total of 7 cases had a history of previous lumbar trauma or surgery. There were 11 (39%), 15 (54%) and 2 (7.1%) cases had right, left and bilateral lumbar hernia, respectively. Superior and inferior lumbar hernia were found in 25 (89%) and 3 (11%) patients. General anesthesia was adopted in 16 cases (group A), whereas 12 patients received local anesthesia (group B). Patients in the group B had a shorter hospital stay than that of the group A (3.5 ± 1.3 days vs. 7.1 ± 3.2 days, p = 0.001), as well as total hospitalization expenses between the two groups (2989 ± 1269 dollars vs. 1299 ± 229 dollars, p < 0.001). With a median follow-up duration of 45.9 months (range: 1–113 months), only 1 (3%) lumbar hernias recurred for the entire cohort. Conclusions Lumbar hernia is a relatively rare entity, and inferior lumbar hernia is rarer. It is feasible to repair lumbar hernia under local anesthesia.