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Surgical Endoscopy

, Volume 25, Issue 5, pp 1665–1665 | Cite as

Laparoscopic lumbar hernia repair with bone anchor fixation

  • Vanessa P. Ho
  • Gregory F. DakinEmail author
Video

Abstract

Introduction

Lumbar hernias are rare defects of the posterolateral abdominal wall. Surgical repair of lumbar hernias is challenging because they are bounded inferiorly by the iliac bone, which makes adequate mesh fixation difficult. We demonstrate a method of a laparoscopic lumbar hernia repair utilizing bone anchor fixation at the inferior border.

Methods

The patient is a 37-year-old male who had been in a motor vehicle collision and presented with a large left lumbar hernia and nonspecific abdominal pain. The patient had a Petit-type hernia that was bordered by the external oblique muscle, the latissimus dorsi, and the iliac crest. We opted to perform a laparoscopic mesh repair. Two Mitek GII QuickAnchor sutures were placed in the anterior superior iliac crest to provide inferior fixation of the mesh, with sufficient overlap of the mesh to prevent recurrence. The remainder of the mesh was fixed with standard laparoscopic tacks and sutures under good visualization to avoid damage of underlying structures.

Results

The patient did well postoperatively and left the hospital on the first postoperative day. He has had no signs of recurrence at follow-up.

Conclusions

The anatomic features of lumbar hernias create several challenges. A number of surgical approaches for lumbar hernia repair have been described, including laparoscopic and open methods as well as intraperitoneal and preperitoneal approaches and the use of flaps to cover the defects. However, limited fixation points for the mesh can lead to high recurrence rates. Bone anchors have been used in a variety of surgical disciplines, including orthopedics, plastic surgery, and gynecologic surgery, with low complication rates of bone pain or infection. We demonstrated a method that utilizes bone anchor fixation in a laparoscopic approach to overcome the challenge of inferior fixation. This securely repairs the hernia with good coverage of the defect while maintaining the benefits of the minimally invasive approach.

Keywords

Latissimus Dorsi Iliac Bone Inferior Border Motor Vehicle Collision Lumbar Hernia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Disclosures

Drs. Ho and Dakin have no conflicts of interest or financial ties to disclose.

Supplementary material

Supplementary material 1 (MPG 99,822 kb)

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Department of SurgeryNewYork-Presbyterian Hospital/Weill Cornell Medical Center, Weill Cornell Medical CollegeNew YorkUSA

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