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A novel technique of lumbar hernia repair using bone anchor fixation

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Abstract

Lumbar hernias are difficult to repair due to their proximity to bone and inadequate surrounding tissue to buttress the repair. We analyzed the outcome of patients undergoing a novel retromuscular lumbar hernia repair technique. The repair was performed in ten patients using a polypropylene or polytetrafluoroethylene mesh placed in an extraperitoneal, retromuscular position with at least 5 cm overlap of the hernia defect. The mesh was fixed with circumferential, transfascial, permanent sutures and inferiorly fixed to the iliac crest by suture bone anchors. Five hernias were recurrent, and five were incarcerated; seven were incisional hernias, and three were posttraumatic. Back and abdominal pain was the most common presenting symptom. Mean hernia size was 227 cm2 (60–504) with a mesh size of 620 cm2 (224–936). Mean operative time was 181 min (120-269), with a mean blood loss of 128 ml (50–200). Mean length of stay was 5.2 days (2–10), and morphine equivalent requirement was 200 mg (47–460). There were no postoperative complications or deaths. After a mean follow-up of 40 months (3–99) there have been no recurrences. Our sublay repair of lumbar hernias with permanent suture fixation is safe and to date has resulted in no recurrences. Suture bone anchors ensure secure fixation of the mesh to the iliac crest and may eliminate a common area of recurrence.

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References

  1. Woodward AM, Flint LM, Ferrara JJ (1999) Laparoscopic retroperitoneal repair of recurrent postoperative lumbar hernia. J Laparoendosc Adv Surg Tech A 9:181–186

    CAS  PubMed  Google Scholar 

  2. Heniford BT, Iannitti DA, Gagner M (1997) Laparoscopic inferior and superior lumbar hernia repair. Arch Surg 132:1141–1144

    CAS  PubMed  Google Scholar 

  3. Astarcioglu H, Sokmen S, Atila K, Karademir S (2003) Incarcerated inferior lumbar (Petit’s) hernia. Hernia 7:158–160

    Article  CAS  PubMed  Google Scholar 

  4. Killeen KL, Girard S, DeMeo JH, Shanmuganathan K, Mirvis SE (2000) Using CT to diagnose traumatic lumbar hernia. AJR Am J Roentgenol 174:1413–1415

    CAS  PubMed  Google Scholar 

  5. Gardner GP, Josephs LG, Rosca M, Rich J, Woodson J, Menzoian JO (1994) The retroperitoneal incision. An evaluation of postoperative flank ‘bulge.’ Arch Surg 129:753–756

  6. Geis WP, Hodakowski GT (1995) Lumbar hernia. In: Nyhus LM, Condon RE (ed) Hernia. Lipincott, Philadelphia, pp 412–424

  7. Sutherland RS, Gerow RR (1995) Hernia after dorsal incision into lumbar region: a case report and review of pathogenesis and treatment. J Urol 153:382–384

    CAS  PubMed  Google Scholar 

  8. Petersen S, Schuster F, Steinbach F, Henke G, Hellmich G, Ludwig K (2002) Sublay prosthetic repair for incisional hernia of the flank. J Urol 168:2461–2463

    Article  PubMed  Google Scholar 

  9. Arca MJ, Heniford BT, Pokorny R, Wilson MA, Mayes J, Gagner M (1998) Laparoscopic repair of lumbar hernias. J Am Coll Surg 187:147–152

    Article  CAS  PubMed  Google Scholar 

  10. Habib E (2003) Retroperitoneoscopic tension-free repair of lumbar hernia. Hernia 7:150–152

    Article  CAS  PubMed  Google Scholar 

  11. Carpenter JE, Fish DN, Huston LJ, Goldstein SA (1993) Pull-out strength of five suture anchors. Arthroscopy 9:109–113

    CAS  PubMed  Google Scholar 

  12. Barber FA, Herbert MA, Richards DP (2003) Sutures and suture anchors: update 2003. Arthroscopy 19:985–990

    Article  PubMed  Google Scholar 

  13. White R, Kneisl JK (1997) A novel approach to reconstruction of inguinal region following sarcoma resection. Presented at the American College of Surgeons, 83rd Clinical Congress, Chicago

  14. Stoppa RE (1989) The treatment of complicated groin and incisional hernias. World J Surg 13:545–554

    CAS  PubMed  Google Scholar 

  15. Lichtenstein IL (1986) Repair of large diffuse lumbar hernias by an extraperitoneal binder technique. Am J Surg 151:501–504

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The authors thank Heather Sullivan for her medical illustration contribution to this manuscript. This manuscript was presented at the 2nd International Hernia Congress in London, UK, on 19 June 2003.

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Correspondence to B. T. Heniford.

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Carbonell, A.M., Kercher, K.W., Sigmon, L. et al. A novel technique of lumbar hernia repair using bone anchor fixation. Hernia 9, 22–25 (2005). https://doi.org/10.1007/s10029-004-0276-8

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  • DOI: https://doi.org/10.1007/s10029-004-0276-8

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