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Retroperitoneal totally endoscopic prosthetic repair of primary lumbar hernia

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A primary lumbar hernia is a rare entity that requires surgical management, but the preferred technique has not been established. We herein describe a standardized and reproducible retroperitoneal totally endoscopic prosthetic (TEP) repair technique for primary lumbar hernias.


Ten adult patients with primary lumbar hernias underwent retroperitoneal TEP repair from February 2019 to July 2020. A sufficient retroperitoneal space was established to accommodate a non-coated polypropylene mesh to reinforce the weakened flank area, and hernia content reduction and defect closure were then performed. The patients’ clinical data were prospectively collected and analyzed.


Nine patients had a primary superior lumbar hernia and one patient had a primary diffuse lumbar hernia. All operations were successfully performed without serious intraoperative complications. The mean defect area was 6.4 ± 2.8 cm2 (range 4–12 cm2), and the mean mesh area was 144.6 cm2 (range 130–180 cm2). The average operative time (skin to skin) was 49.0 ± 5.7 min (range 40–60 min), and intraoperative bleeding was minimal. The mean visual analog pain scale score at rest on the first postoperative day was 2.2 (range 2–3). The average length of postoperative stay was 1.5 days (range 1–2 days). No serious postoperative complications occurred. No recurrence, chronic pain, or mesh infection occurred during a mean follow-up period of 7.5 months.


The retroperitoneal TEP repair for primary lumbar hernias is safe, efficient, and reproducible. Anti-adhesive coated meshes and fixation tackers are not required, making this a cost-effective procedure that is worthy of recommendation.

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We thank Dr. Si X and Dr. Hua L from Shanghai, Dr. Miao J from Guangdong, Dr. Yang G, Dr. Jiang L, Dr. Gong Y and Dr. Zeng Y from Sichuan, Dr. Liu G from Zhejiang, Dr. Zhang L from Henan for their valuable contributions to this paper.


This work was supported by the Beijing Hospitals Authority Youth Programme (Code: QML20170307).

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Correspondence to G. Li.

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This study was approved by the institutional ethical review boards of all involved hospitals.

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All procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional review board/international ethics committee for each center and with the 1964 Helsinki declaration and its later amendments. This article does not contain any studies with animals performed by any of the authors

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All patients provided informed consent preoperatively.

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Li, B., Yu, J., Qin, C. et al. Retroperitoneal totally endoscopic prosthetic repair of primary lumbar hernia. Hernia 25, 1629–1634 (2021).

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