Heniford B T, Iannitti D A, Gagner M
Department of General Surgery, Cleveland Clinic Foundation, Ohio, USA.
Arch Surg. 1997 Oct;132(10):1141-4. doi: 10.1001/archsurg.1997.01430340095017.
Lumbar hernias are rare defects that involve the extrusion of retroperitoneal fat or viscera through a weakness in the posterior abdominal wall. Repairing these hernias is often difficult because of the weakness of the surrounding structures. Techniques for reconstruction usually include an incision from the 12th rib to the iliac crest with mobilization of local flaps or onlay fascial flaps or the use of prosthetic mesh. Contemporary reports have advocated extensive retroperitoneal dissection with the placement of permanent mesh extraperitoneally. We have recently repaired an extensive, primary lumbar hernia laparoscopically, securing the mesh to the 12th rib superiorly, iliac crest inferiorly, erector spinae fascia medially, and external oblique fascia laterally. The patient resumed normal activities in less than 2 weeks; 4 months postoperatively, he seems to have a solid repair. To our knowledge, this is the first report of this technique.
腰疝是一种罕见的缺损，涉及腹膜后脂肪或内脏通过腹壁后部的薄弱处突出。由于周围结构薄弱，修复这些疝通常很困难。重建技术通常包括从第12肋至髂嵴做切口，游离局部皮瓣或外置筋膜瓣，或使用人工补片。当代报告主张进行广泛的腹膜后解剖，并将永久性补片放置在腹膜外。我们最近通过腹腔镜修复了一例广泛的原发性腰疝，将补片向上固定于第12肋，向下固定于髂嵴，内侧固定于竖脊肌筋膜，外侧固定于腹外斜肌筋膜。患者在不到2周的时间内恢复了正常活动；术后4个月，修复似乎很牢固。据我们所知，这是该技术的首次报告。
