Clinical analysis of lumbar hernia tension-free repair through retroperitoneal space: A report 7 cases

doi:10.19538/j.cjps.issn1005-2208.2017.02.20

Abstract：Objective To evaluate the clinical experience of lumbar hernia tension-free repair with a Kugel patch through retroperitoneal space. Methods The clinical data of 7 cases of lumbar hernia tension-free repair with a Kugel patch through retroperitoneal space performed from December, 2008 to December, 2015 in Department of General Surgery, Union Hospital, Fujian Medical University were analyzed retrospectively. Follow-up was performed through outpatient service or telephone interview till June, 2016. Postoperative complications were summarized and the clinical effectiveness of the procedure was analyzed. Results Seven cases underwent lumbar hernia repair smoothly under general anesthesia, 5 cases with a 11 cm×14 cm Kugel patch and 2 cases with a 14 cm×17 cm one. Transfixing stitches were adapted in order to ensure the positioning of the mesh. The mean operative time was 65.2 min. Mean blood loss was 45.5 mL. A closed drainage tube was routinely placed in front of the patch with a mean removal time of 3.6 days. Early ambulation was encouraged with no limit to anesthesia. A semi-liquid diet was then restored 6 hours after the operation and pressure dressing was routinely adapted till 3 months after the operation. The mean length of postoperative hospitalization was 2.8 days. All patients were followed up for 6 to 78 months (average 32.7 months). A previous mesh was removed in a recurrent lumbar hernia before repair. An ipsilateral inguinal indirect hernia was repaired with Kugel procedure, and an ipsilateral lumbar cyst with the hernia was resected during the operation. No postoperative complication occurred, including seroma, hematoma, recurrence, incisional infection, chronic pain, and foreign body sensation. Conclusion Lumbar hernia tension-free repair with a Kugel patch through retroperitoneal space, adapting transfixing stitches for fixation, is a safe and useful technique, which is associated with effective repair, few postoperative complications, rapid recovery and good clinical results.