Lumbar Hernia Repair

LUMBAR HERNIA REPAIR

Introduction

Procedure

Only 300 cases of lumbar hernias have been reported in the literature and only two were repaired laparoscopically.
Incarcerated lumbar hernias are unusual since the neck of the sac is generally broad. Hernia contents may include small/large intestine, mesentery, omentum, appendix, cecum, stomach, ovary, spleen, or kidney

Diagnosis: CT scan of abdomen

Differential Diagnosis
Lipoma
Soft tissue tumors
Fibroma
Rhabdomyoma
Sarcoma
Lumbar hernia
Renal Tumors – cystic, solid

60 y/o male from Africa complaining of intermittent right flank pain
History of progressively enlarging right flank mass for two years
Occasional nausea and vomiting

Past Medical History
Graves’ Disease ? Status Post Thyroidectomy
(+) PPD – TB therapy
Anterior Mediastinal Mass
Pulmonary Hypertension
GERD

Pertinent Physical Examination
3-4 cm mass, moderately tender on palpation, located in posterior flank below costal margin
No adenopathy noted
No other significant findings

Multimedia

Surgical Technique
(click screen to view procedure)

Left lateral decubitus position
Positioned with Flank over Break in Table
Three trocars
Enter Retroperitoneum with Colon Takedown
Mesh Repair