Laparoscopic Repair of Left Lumbar Hernia After Laparoscopic Left Nephrectomy

Michel Gagner, MD, FACS, Luca Milone, MD, Patricia Turner, MD

Product Details
Product ID: ACS-2284
Year Produced: 2004
Length: 10 min.


Lumbar hernias are rare defects in the postero-lateral abdominal wall; approximately 300 cases have been described in the literature. There have been no documented cases, however of lumbar hernias through trocar sites, after laparoscopic retroperitoneal nephrectomy. The objective is to assess the feasibility and safety of the laparoscopic approach for lumbar hernia repair through trocar sites. 62-year old male with a past medical history for arthritis, CAD, depression status-post a lumbar laparoscopic left nephrectomy for chronic pylonephritis 10 years earlier. The patient's complaint was a bulge in left flank. A CT scan revealed a left-sided hernia between the longissimus and latissimus dorsi muscles containing the splenic flexure of the colon and retroperitoneal fat. Three abdominal trocars were used. Three defects were visualized, the biggest of which contained part of the splenic flexure. The parietal peritoneum was opened and the colon mobilized, each of the defects was filled with retroperitoneal fat that needed to be dissected free. Once the hernias were reduced, a (15 x 10 cm) polypropylene mesh was positioned and fixed in place. The parietal peritoneum was closed over the mesh. No drains were placed. The postoperative course was uncomplicated, and the patient was discharged on postoperative day one. The OR time was 60 minutes. Laparoscopic lumbar hernia is a safe procedure with minimal postoperative pain and rapid recovery. All trocar sites in the lumbar area should be closed to prevent this complication after laparoscopic nephrectomy, adrenalectomy or other retroperitoneal procedures.