Laparoscopic hernioplasty in secondary lumbar hernias.

BACKGROUND: Lumbar hernia is an uncommon defect of the posterior abdominal wall, and surgical treatment is still controversial. The aim of this study was to analyze the utility of the laparoscopic approach in the repair of these hernias. MATERIALS AND METHODS: We undertook a descriptive analysis of 15 patients diagnosed with lumbar hernia who underwent surgery with transabdominal laparoscopy between 1997 and 2004. The following variables were analyzed: clinical data, intraoperative and postoperative complications, operative time, length of hospital stay, analgesic consumption, and recurrences. The technique was evaluated aesthetically by measuring the abdominal perimeter using a tape measure. The mean follow-up was 32 months (range, 12-55 months). RESULTS: Intraoperative morbidity consisted of two cases of bleeding caused by the mechanical suture. Postoperative morbidity consisted of 3 cases of hematomas, 2 of seromas, and 2 of transitory pain. Seven patients (47%) were treated as day cases, and only one required admission due to pain. At 12-month follow-up we found one recurrence and a significant reduction in abdominal perimeter (P < 0.05). CONCLUSION: The transabdominal laparoscopic approach offers good clinical and aesthetic results both for the patient and the hospital, as almost half of the cases can be treated as day cases. We believe it should be considered the technique of choice for incisional lumbar hernia repair.

Reparación laparoscópica de las hernias lumbares secundarias: cirugía abierta frente a laparoscópica. Estudio prospectivo no aleatorizado / Laparoscopic repair of secondary lumbar hernias: open vs. laparoscopic surgery. A prospective, non randomized study

Introducción. La hernia lumbar es un defecto de la pared abdominal posterior poco frecuente y su tratamiento quirúrgico es todavía controvertido. El objetivo del estudio es valorar la utilidad de la vía laparoscópica frente a la cirugía abierta. Pacientes y método. Estudio prospectivo no aleatorizado con 16 pacientes intervenidos por hernia lumbar secundaria entre enero de 1997 y enero de 2003: 9 mediante vía laparoscópica y 7 por vía abierta. Las variables analizadas fueron: datos clínicos y hospitalarios (tiempo quirúrgico y estancia), bienestar del paciente (consumo de analgésicos y retorno a su actividad habitual) y recurrencias. Se realiza un análisis del coste hospitalario del proceso. Resultados. No encontramos diferencias entre ambos grupos en cuanto a la edad y los antecedentes, aunque el tamaño de los defectos operados por laparoscopia fue menor. El tiempo quirúrgico medio, la morbilidad postoperatoria, la estancia hospitalaria media, el consumo de analgésicos y el retorno a la actividad habitual fueron significativamente menores en el grupo laparoscópico (p < 0,01). El coste hospitalario del proceso no presentó diferencias estadísticas en función del abordaje quirúrgico, pero sí el coste final tras incluir los gastos por reingreso y recidiva (p < 0,01). Conclusiones. En nuestra serie, la vía laparoscópica puede ser empleada en la reparación de las hernias lumbares secundarias con una mayor eficacia y rentabilidad que la vía abierta tradicional y con el mismo coste (AU)

Introduction. Lumbar hernia is an uncommon defect of the posterior abdominal wall and its surgical treatment remains controversial. The aim of the present study was to evaluate the utility of laparoscopy versus open surgery. Patients and method. We performed a prospective, nonrandomized study of 16 patients with secondary lumbar hernias who underwent surgery between January1997 and January 2003. Nine patients underwent laparoscopy and 7 underwent open surgery. The variables analyzed were clinical features, hospital data (operating time and length of hospital stay), patient comfort (analgesic consumption and return to normal daily activity) and recurrences. Hospital costs were also analyzed. Results. No differences were found between the two groups in age or history, although the size of laparoscopically-repaired defects was smaller. Mean operating time, postoperative morbidity, mean length of hospital stay, analgesic consumption, and return to daily activities were significantly lower in the laparoscopic group (P<.01). No statistically significant differences in the cost of the process were found according to surgical approach but significant differences were found in final cost after including the cost of readmissions and recurrences (P<.01). Conclusions. In our series, the laparoscopic approach was more effective than traditional open surgery in the repair of secondary lumbar hernias while the cost of the two procedures was the same (AU)

[Laparoscopic repair of secondary lumbar hernias: open vs. laparoscopic surgery. A prospective, nonrandomized study]. / Reparación laparoscópica de las hernias lumbares secundarias: cirugía abierta frente a laparoscópica. Estudio prospectivo no aleatorizado.

INTRODUCTION: Lumbar hernia is an uncommon defect of the posterior abdominal wall and its surgical treatment remains controversial. The aim of the present study was to evaluate the utility of laparoscopy versus open surgery. PATIENTS AND METHOD: We performed a prospective, nonrandomized study of 16 patients with secondary lumbar hernias who underwent surgery between January 1997 and January 2003. Nine patients underwent laparoscopy and 7 underwent open surgery. The variables analyzed were clinical features, hospital data (operating time and length of hospital stay), patient comfort (analgesic consumption and return to normal daily activity) and recurrences. Hospital costs were also analyzed. RESULTS: No differences were found between the two groups in age or history, although the size of laparoscopically-repaired defects was smaller. Mean operating time, postoperative morbidity, mean length of hospital stay, analgesic consumption, and return to daily activities were significantly lower in the laparoscopic group (P<.01). No statistically significant differences in the cost of the process were found according to surgical approach but significant differences were found in final cost after including the cost of readmissions and recurrences (P<.01). CONCLUSIONS: In our series, the laparoscopic approach was more effective than traditional open surgery in the repair of secondary lumbar hernias while the cost of the two procedures was the same.