Transperitoneal preperitoneal laparoscopic lumbar incisional herniorrhaphy

Purpose: Flank incisions may be associated with flank hernias, which may be complicated by incarceration and strangulation. Furthermore, they may be t he cause of significant patient dissatisfaction with the surgical outcome. To avoid an open surgical procedure with its associated morbidity for herni a repair we describe a novel laparoscopic technique for repairing flank her nias with minimal morbidity and an excellent outcome. Materials and Methods: Three cases of flank hernia were managed by the tran speritoneal preperitoneal laparoscopic approach using polypropylene mesh to repair the fascial defect. An initial transperitoneal approach helps to id entify the limits of the hernia. A 2 to 3 cm. margin of overlying peritoneu m is incised around the hernia margin. It is important not to dissect overl ying bowel. The mesh is placed behind the peritoneal envelope and secured w ith hernia staples. Results: All cases were managed successfully via laparoscopy. There were no intraoperative or postoperative complications. At a mean followup of 12 mo nths cosmesis has been excellent and there have been no recurrences. Conclusions: We describe a minimally invasive, versatile technique for lapa roscopic repair of flank incisional hernias with excellent functional and c osmetic results. This approach avoids the significant morbidity associated with open repair of incisional flank hernias.