Evaluation of Medium-Term Clinical Outcomes and Surgical Experience Using the Totally Extraperitoneal Technique in Primary and Secondary Lumbar Hernia Repair.

Abstract

<h4>Introduction</h4>Lumbar hernias are rare abdominal wall defects, either primary or secondary, with symptoms like flank masses or bowel obstruction. Though uncommon, incarceration occurs in about 9% of cases, necessitating early surgical intervention. While both open and laparoscopic repairs are viable, laparoscopic methods, especially the totally retroperitoneal endoscopic approach, have shown promising outcomes despite the technical challenges associated with this technique. Over the past 5 years, we employed this technique in various lumbar hernias, with favorable recovery results, highlighting its clinical potential.<h4>Methods</h4>Patients with lumbar hernias, each located within the superior lumbar triangle, were prospectively enrolled in this study. All hernias were repaired using the totally extraperitoneal (TEP) technique, which allows for complete extraperitoneal access. Detailed descriptions of the surgical technique are provided, and perioperative outcomes were systematically recorded and analyzed.<h4>Results</h4>Seventeen patients underwent TEP repair for lumbar hernias, including one with bilateral hernias. The cohort had a mean age of 62 years and a mean BMI of 26.1 kg/m². Hernia defects ranged from 2 to 6 cm, with equal proportions of primary and secondary types. The median hospital stay was 3 days, and the median postoperative pain score was 3. Over 6-48 months of follow-up, no recurrences or serious complications were observed.<h4>Conclusion</h4>This study demonstrated that the TEP approach is a feasible, safe, and technically straightforward method for repairing upper lumbar hernias. Given the rarity of lumbar hernias, larger studies with extended follow-up are warranted to confirm the long-term efficacy of this technique.