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1.
Michel Gagner Luca Milone Andrew Gumbs Patricia Turner 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2010,14(3):405-409
Lumbar hernias, rarely seen in clinical practice, can be acquired after open or laparoscopic flank surgery. We describe a successful laparoscopic preperitoneal mesh repair of multiple trocar-site hernias after extraperitoneal nephrectomy. All the key steps including creating a peritoneal flap, reducing the hernia contents, and fixation of the mesh are described. A review of the literature on this infrequent operation is presented. Laparoscopic repair of lumbar hernias has all the advantages of laparoscopic ventral hernia repair. 相似文献
2.
Laparoscopic tension-free hernioplasty for lumbar hernia 总被引:2,自引:0,他引:2
Lumbar hernia, a defect of the posterior abdominal wall, is a very rare condition. The repair of a posterior abdominal wall hernia by simply closing the hernia port with sutures may not be adequate, especially when the herniation is due to a weakness in the abdominal wall. Recently, a simple, logical method of tension-free repair has become a popular means for the treatment of various abdominal wall hernias. Previous studies have advocated the use of tension-free repair for lumbar hernia; the technique uses a mesh replacement and requires an extensive incision. Herein we present a case of superior lumbar hernia. Our technique consisted of a laparoscopic tension-free hernioplasty with the application of a Prolene mesh. This technique, which provides an excellent operative view, is safe, feasible, and minimally invasive. We conclude that laparoscopic tension-free repair should be the preferred option for the treatment of lumbar hernia. 相似文献
3.
Lumbar hernias are a protrusion of intra-abdominal contents through a weakness or rupture in the posterior abdominal wall. They are considered to be a rare entity with approximately 300 cases reported in the literature since it was first described by Barbette in 1672. Petit described the inferior lumbar triangle in 1783 and Grynfeltt described the superior lumbar triangle in 1866; both are anatomical boundaries where 95 % of lumbar hernias occur, whereas the other 5 % are considered to be diffuse. Twenty percent of lumbar hernias are congenital and the other 80 % are acquired; the acquired lumbar hernias can be further classified into either primary (spontaneous) or secondary. The typical presentation of lumbar hernias is a patient with a protruding semispherical bulge in the back with a slow growth. However, they may present with an incarcerated or strangulated bowel, so it is recommended that all lumbar hernias must be repaired as soon as they are diagnosed. The “gold standard” for diagnosing a lumbar hernia is a CT scan, because it is able to delineate muscular and fascial layers, detect a defect in one or more of these layers, evaluate the presence of herniated contents, differentiate muscle atrophy from a real hernia, and serve as a useful tool in the differential diagnosis, such as tumors. Recent studies have demonstrated the advantages of a laparoscopic repair instead of the classic open approach as the ideal treatment option for lumbar hernias. We report a case of a spontaneous lumbar hernia initially diagnosed as a lipoma and corrected with the open approach, but after relapsing 2 years later it was corrected using a laparoscopic approach. It is followed by an extensive review of lumbar hernias literature regarding history, anatomy, and surgical techniques. 相似文献
4.
IntroductionLumbar hernias are considered rare and they constitute less than 1.5% of all abdominal wall hernias.Case reportHere we present a case of a 72-year-old female with a left flank swelling since 2-years diagnosed as a lumbar incisional hernia. This lumbar incisional hernia1 was repaired successfully using polypropylene mesh strip sutures.2DiscussionMany surgical techniques have been described for repair of LIH. Suture repair, mesh repair and myofascial flaps have been described for lumbar hernias. Repairing a lumbar hernia can be surgically challenging because of its proximity to bony structures, which can limit proper dissection and mesh overlap. We performed defect closure with PMSS. Patient has no recurrence after 2 years of follow up.ConclusionIn our case of left lumbar incisional hernia, defect closure with PMSS was an effective operation. This technique may also be effective in potentially contaminated settings due to reduced implant load. Further studies are required to understand its biomechanics and long-term outcomes. 相似文献
5.
Meinke AK 《Surgical endoscopy》2003,17(5):734-737
Background: The repair of congenital and acquired lumbar hernias has remained a significant surgical challenge for over three centuries. Transperitoneal laparoendoscopic techniques have been reported that have achieved success in repairing these difficult hernias using a variety of synthetic mesh. Careful review of the surgical literature addressing the repair of lumbar hernia reveals that only fourteen successful cases have been reported using minimally invasive techniques. All of these cases elected a transperitonal approach to repair. Encouraged by established success in the repair of inguinal hernia using an extraperitoneal approach, the repair of a large inferior triangle lumbar hernia was attempted using overlapping synthetic mesh technique while remaining entirely in an extraperitoneal plane. Methods: A seventy-eight-year-old patient presented for repair of a large symptomatic right lumbar hernia, one year following iliac bone harvest for lumbar laminectomy/fusion. Under general anesthesia, the patient was placed in a lateral decubitus position with lumbar roll in place. Using a muscle splitting dissection through the lateral abdominal musculature, a plane was developed bluntly between the transversalus muscle and the peritoneum. Using a three trocar technique, the plane was matured posteriorly, achieving an ample working space to identify the hernia and complete a synthetic mesh (PTFE) repair. Results: A large inferior triangle lumbar hernia was successfully repaired using overlapping synthetic mesh technique while remaining entirely in an extraperitoneal plane. Eighteen month reevaluation including physical examination and computer tomographic (CT) study confirms successful repair without recurrence of symptoms. Conclusions: A totally extraperitoneal approach to the identification, mobilization, and repair of lumbar hernia can be successfully accomplished using established laparoendoscopic surgical techniques. 相似文献
6.
Saber AA 《Surgical endoscopy》2004,18(1):162-164
Laparoscopic ventral hernia repair has many advantages over the open approach. Mesh placement and orientation to overlap the hernia defect is a crucial step. The current techniques for mesh placement are time-consuming. A simple technique for mesh placement during laparoscopic ventral hernia repair is described. 相似文献
7.
Wright BE Beckerman J Cohen M Cumming JK Rodriguez JL 《American journal of surgery》2002,184(6):505-8; discussion 508-9
BACKGROUND: Laparoscopic mesh repair has been advocated as treatment of choice for ventral hernias. The term "ventral hernia" refers to a variety of abdominal wall defects and laparoscopic papers have not reported defect specific analysis. The purpose of this study was to determine any advantages to laparoscopic mesh repair of umbilical hernias. METHODS: A retrospective review (January 1998 to April 2001) was made of patients undergoing umbilical hernia repair. Patients were categorized into three groups: laparoscopic repair with mesh, open repair with mesh, and open repair without mesh. Comparative analysis was performed. RESULTS: One-hundred and sixteen umbilical hernia repairs were performed in 112 patients: 30 laparoscopic mesh repairs, 20 open mesh repairs, and 66 open nonmesh repairs. The laparoscopic technique was used for larger defects and took more time with a trend toward fewer postoperative complications and recurrences. CONCLUSIONS: Laparoscopic umbilical hernia repair with mesh presents a reasonable alternative to conventional methods of repair. 相似文献
8.
During laparoscopic ventral hernia repair (LVHR), it is not always possible to reduce incarcerated omentum through a tight
defect and it may tear or require transection within the abdomen. This leaves an ischemic mass of tissue within the hernia
sac which can cause pain, infection, or the appearance of hernia recurrence postoperatively. We describe a technique which
allows extraction of any retained omentum within the hernia sac, mesh insertion, and laparoscopic completion of the procedure
using only 5 mm trocars.
After obtaining access to the abdomen with a 5 mm optical trocar in select patients, lysis of adhesions is performed as needed.
When incarcerated omentum that cannot be safely reduced is discovered, it is transected at the level of the abdominal wall
using electrocoagulation or ultrasonic dissection. At this point, we make a 2–3 cm skin incision overlying the retained omentum,
open the hernia sac, and remove the amputated omentum. The rolled up piece of mesh utilized for the repair is then inserted
through this opening. The hernia sac is closed with absorbable suture, allowing reinsufflation of the abdomen and completion
of the laparoscopic repair.
This method enables us to safely remove any retained omentum from the hernia sac and utilize the same incision for mesh insertion.
We utilize only 5 mm trocars without the need for a larger port through which to place the mesh into the abdomen. This reduces
the risk of postoperative trocar site hernias as the opening for mesh insertion is covered by the mesh after it is fixed in
place. This technique may also decrease the need for conversion to open hernia repair by allowing an alternative approach
to reduce incarcerated omentum. 相似文献
9.
Farshad Abir Dan Eisenberg Robert Bell 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2005,9(1):94-96
OBJECTIVE: High recurrence rates have been documented after primary repair of incisional hernias. Laparoscopic ventral and incisional hernia repairs have been performed with very low rates of recurrence. We have modified the standard technique of laparoscopic repair in patients with small incisional and ventral hernias. The purpose of this study was to document the technique utilizing only two 5-mm ports and demonstrate that it is safe, effective, and feasible. METHODS: Three patients with small incisional or ventral hernias were examined. The standard laparoscopic ventral hernia repair technique was modified as follows: two 5-mm ports were inserted on opposite sides of the defect. The defects ranged from 2.5 cm to 4 cm in size. Expanded polytetrafluoroethylene mesh (DualMesh, WL Gore, Flagstaff, AZ) was used to cover the hernia defect, overlapping the defect margins circumferentially by 3 cm. The mesh diameter ranged from 8.5 cm to 10 cm. The mesh was inserted through a 5-mm skin incision site and affixed into position with transfascial sutures and spiral tacks. RESULTS: The operative time ranged from 53 minutes to 57 minutes. All patients were discharged home the day of surgery and reported minimal postoperative pain. Follow-up ranged from 6 months to 1 year; all patients were doing well without recurrence. CONCLUSION: Laparoscopic repair of ventral or incisional hernias can be performed using only two 5-mm ports. This technique can be done on an outpatient basis in a safe, timely fashion. 相似文献
10.
Shekarriz B Graziottin TM Gholami S Lu HF Yamada H Duh QY Stoller ML 《The Journal of urology》2001,166(4):1267-1269
PURPOSE: Flank incisions may be associated with flank hernias, which may be complicated by incarceration and strangulation. Furthermore, they may be the cause of significant patient dissatisfaction with the surgical outcome. To avoid an open surgical procedure with its associated morbidity for hernia repair we describe a novel laparoscopic technique for repairing flank hernias with minimal morbidity and an excellent outcome. MATERIALS AND METHODS: Three cases of flank hernia were managed by the transperitoneal preperitoneal laparoscopic approach using polypropylene mesh to repair the fascial defect. An initial transperitoneal approach helps to identify the limits of the hernia. A 2 to 3 cm. margin of overlying peritoneum is incised around the hernia margin. It is important not to dissect overlying bowel. The mesh is placed behind the peritoneal envelope and secured with hernia staples. RESULTS: All cases were managed successfully via laparoscopy. There were no intraoperative or postoperative complications. At a mean followup of 12 months cosmesis has been excellent and there have been no recurrences. CONCLUSIONS: We describe a minimally invasive, versatile technique for laparoscopic repair of flank incisional hernias with excellent functional and cosmetic results. This approach avoids the significant morbidity associated with open repair of incisional flank hernias. 相似文献
11.
Background Perineal hernia is an uncommon complication following abdominoperineal resection of the rectum. There are only a few reports
concerning the management of this unusual problem. Various methods of repair have been described, but none of them is well
established. The purpose of our study is to present our experience and to discuss the pathogenesis and the different surgical
repair techniques of these hernias.
Methods Between September 2003 and December 2004, four patients with perineal hernia observed several months following laparoscopic
abdominoperineal resection for adenocarcinoma of the lower rectum were treated. All patients underwent the transabdominal
laparoscopic approach using synthetic mesh for repair.
Results In all patients, the hernia was repaired by the laparoscopic transabdominal approach using synthetic mesh. The blood loss
was minimal and mean operating time was 54 ± 10 min. There were no cases that required conversion to laparotomy and there
were no intraoperative or postoperative complications. Beginning of soft diet intake and ambulation times were on the second
day following surgery. The average length of hospital stay was 4 ± 1 days. During 8.3 ± 6 months of follow-up, there was no
recurrence of the hernia.
Conclusion Perineal hernias are rare complications of major pelvic surgeries. Symptomatic hernias should be repaired surgically. The
transabdominal laparoscopic approach using synthetic mesh provides an appropriate solution for these hernias. 相似文献
12.
Lumbar hernias are rare defects in the posterolateral abdominal wall that may be congenital or acquired. We present a case of laparoscopic approach to repair an acquired inferior triangle (Petit) lumbar hernia in a woman by using polytetrafluoroethylene mesh. The size of the hernia was 8×10 cm. The length of her hospital stay was 2 days. The patient resumed normal activities in less than 2 weeks. The main advantage of this approach is excellent operative visualization, thus avoiding injury to structures near the hernia during repair. Patients benefit from a minimally invasive approach with less pain, shortened hospital course, less analgesic requirements, better cosmetic result, and minimal life-style interference. 相似文献
13.
Purpose Incisional lumbar hernia is an uncommon hernia type. Open surgical procedures have significant postoperative morbidity and
patient dissatisfaction, therefore, for the repair of seven incisional lumbar hernias, we attempted using an intraperitoneal
laparoscopic technique that was described to have good short-term results and decreased morbidity.
Methods We applied a laparoscopic technique using polypropylene meshes in five patients and composite meshes in two patients to cover
the defect, then placed prolene sutures and hernia staples to secure the mesh intraperitoneally.
Result The technique was successful in all patients, and they tolerated the procedure well. All did well after surgery, ambulating
and eating a regular diet on postoperative day 1. No postoperative complications developed. At a mean follow-up of 34.1 months
(range 17–43 months) none of them had pain, mass, or evidence of recurrence, and furthermore, cosmesis was excellent.
Conclusions We believe that the laparoscopic approach is feasible, safe, and the least invasive choice for repairing difficult hernias
such as incisional lumbar hernias. 相似文献
14.
15.
The aim of the present case report is to present the diagnostic and therapeutic challenge of intercostal incisional hernia.
We report on a female patient with leftsided intercostal incisional hernia between the eleventh and twelfth rib due to preceding
lumbar incision for tumor nephrectomy. Because of its infrequence, diagnosis was established late although simple clinical
examination and ultrasound investigation displayed the hernia. At laparotomy, a 5×5 cm2 fascial defect with a colonic sliding hernia was found. Hernia repair using permanent mesh reinforcement in the retromuscular
position is described. Abdominal incisional hernia in the intercostal region is rare and therefore easily overlooked. As with
other incisional hernias, the hernia repair using mesh implantation in the retromuscular region is technically feasible and
represents the treatment of choice. 相似文献
16.
Summary Reluctance to repair anterior abdominal wall hernias in women of childbearing age is probably unjustified. A unique series is described of 27 women who gave birth to 41 full-term babies following repair of an anterior abdominal wall hernia with no recurrence of the hernia. Nineteen had primary and recurrent umbilical hernias and an incisional hernia in a low transverse incision repaired by the onlay darn technique and have produced 29 babies. Eight had umbilical hernias, gross diastasis of the recti and post-cesarean section vertical incisional hernias repaired by the Shoelace technique followed by 12 full-term pregnancies. Little is written about the fate of the abdominal wall subjected to pregnancies following repair of ventral hernias, since the majority of women having these hernias repaired are past the child-bearing age or are warned off further pregnancies by their doctors or undergo tubal ligation with the hernia repair. The Shoelace repair is described, stressing its advantages over mesh hernioplasties in women who wish to have further pregnancies. There is apparently no reason to refuse to repair these hernias. There are even positive indications in view of serious complications associated with pregnancy in the presence of an anterior wall hernia. Prosthetic mesh tends to contract and harden and may seriously interfere with abdominal expansion in pregnancies so these hernias are probably best repaired by the Shoelace technique. 相似文献
17.
Laparoscopic management of lumbar hernia 总被引:1,自引:1,他引:0
We describe (for the first time) a laparoscopic approach to repair an acquired superior triangle lumbar hernia in a morbidly
obese woman by using prosthetic mesh. Such a technique provides an excellent anatomic view, thus avoiding injury to structures
in proximity to the hernia during repair; eventually the well-known advantages of such approach result.
Received: 10 November 1996/Accepted: 20 December 1996 相似文献
18.
Shawn Tsuda 《International journal of surgery case reports》2014,5(12):1167-1169
INTRODUCTION
Complex hernias continue to present a challenge. Surgical techniques for repair are carefully considered to reduce risk for complications. Laparoscopic repairs improve postoperative infection rates, and placement of biologic mesh decreases mesh infection rates. However, laparoscopic repairs using biologic mesh is generally challenging due to difficulty with maneuverability.PRESENTATION OF CASE
We present a case of a complex ventral hernia that was laparoscopically repaired using a new FDA cleared laparoscopic biologic graft. The patient had multiple comorbidities, including obesity, hepatitis C, endocarditis secondary to IV drug use, tobacco smoking, bilateral inguinal hernia, and recurrent umbilical hernia. The recurrent hernia was larger, irreducible, and discolored compared to original defect. The patient underwent laparoscopic repair with primary closure and reinforcement with Strattice™ Tissue Matrix Laparoscopic (LifeCell Corporation, Branchburg, NJ). At nine months postoperative, the patient had no evidence of recurrence, infection, or chronic pain, demonstrating early success from the surgical management.DISCUSSION
Presence of multiple comorbidities and incarcerated recurrent hernia increase risk for complications during and/or after hernia repair. Considering these factors, laparoscopic repair with Strattice Laparoscopic and defect closure was a reasonable technique for repair.CONCLUSION
Laparoscopic suture repair reinforced with biologic dermal tissue matrix was successfully performed during a complex hernia repair. 相似文献19.
Oliver Varban 《International journal of surgery case reports》2013,4(10):869-871
INTRODUCTIONLumbar hernia is a rare complication that can occur after breast reconstruction using a latissimus dorsi flap. The defect occurs within the superior lumbar triangle and may result in visceral incarceration.PRESENTATION OF CASEWe report a 61-year-old female who presented with a left sided lumbar bulge and pain 7 years following a modified radical mastectomy and latissimus dorsi flap reconstruction. Computed tomography demonstrated a lumbar hernia with incarcerated colon. The patient underwent a successful laparoscopic repair with prosthetic mesh underlay.DISCUSSIONLumbar hernias may be congenital, secondary to trauma or prior surgery. Imaging studies assist in excluding soft tissue tumors, infections, hematoma or abdominal wall denervation atrophy, which may also present as a lumbar bulge. Repair may be performed in an open, laparoscopic or retroperitoneoscopic approach.CONCLUSIONLaparoscopic lumbar hernia repair with mesh is a safe and feasible way to manage an uncommon complication after breast reconstruction with a latissimus flap. 相似文献
20.
Catherine Baucom Quan D. Nguyen Marco Hidalgo Douglas Slakey 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2009,13(2):263-268