Incisional lumbar hernias: Current role of laparoscopic approach with intraperitoneal onlay mesh procedure

Abstract

Lumbar incisional hernias are a defect of the posterolateral region on the abdominal wall that originated from previous surgical incisions in the area. A surgical approach is challenging due to low incidence and the lack of enough publications on the topic, which generates controversies among surgeons. The purpose of this paper is to show our laparoscopic approach experience using the intraperitoneal onlay mesh (IPOM) and IPOM Plus procedures for the treatment of lumbar incisional hernias. This was a retrospective descriptive study, including 10 patients with lumbar/posterolateral incisional hernias, diagnosed by computerized tomography scan and surgically treated with the IPOM laparoscopic technique in one case and IPOM Plus in nine cases from 2014 to 2021. Demographic data and baseline characteristics of enrolled patients were assessed, as well as perioperative data, surgical time, length of hospital stay, and recurrence during an average 38.6-month follow-up. In the series assessed, the defect size ranged between 24 and 72 cm2, with mean longitudinal and transversal diameters of 7.9 and 5.8 cm, respectively. The surgery lasted 120–180 min. There were no cases of conversion or intraoperative visceral lesions. Nine patients were discharged on an average of 37.8 ± 8.9 h after admission, and one patient stayed for 64 h due to extra analgesic demand. Postoperative morbidity was a case of hematoma. There was one case of recurrence. The results of our experience have shown the benefits of the laparoscopic approach with the IPOM Plus method for the treatment of lumbar incisional hernias, including short hospital stays and low incidence of postoperative complications. Accordingly, this mainstream technique, which has shown good outcomes both in the short and the long term, appears to be a simple and safe procedure.