腰疝是罕见的腹壁疝,发生在后外侧腹壁。腹膜内或腹膜外内容物通常通过两个解剖三角形之一的缺陷突出。上腰椎三角形(Grynfeltt-Lesshaft三角形)是一个倒三角形,上面是第12根肋骨,内部斜肌横向,和中间的竖脊肌。下腰椎三角形(Petit\'s三角形)是一个直立的三角形,由the骨下方接壤,外侧斜肌,和背阔肌内侧。已经描述了通过开放或腹腔镜方法进行的手术修复。一名69岁男性患者出现右侧腹部疼痛和肿胀。他10个月前发生了一起摩托车事故,这可能导致了CT扫描显示的创伤性腰疝的发展。疝气是临床上嵌顿的,缺损包括盲肠和回盲瓣。注意到缺损正好高于髂骨,根据定义,使其成为下腰椎疝或小疝。疝通过机器人辅助腹腔镜经腹入路修复。创建腹膜瓣,露出筋膜缺损。筋膜主要用缝合修复。在腹膜前间隙用11.4厘米的圆形VentralightST网孔加固了缺损。患者对手术耐受良好,无急性并发症。他在门诊当天出院,并进行了适当的疼痛控制。短期随访显示无复发疝出现,症状缓解。腰椎疝是罕见的,没有黄金标准的修复技术。已经描述了腹腔镜方法相对于开放方法的益处。此病例报告描述了利用微创方法主要修复腰椎疝缺损,同时还在腹膜前间隙用网片增强疝。
Lumbar hernias are rare abdominal wall hernias that occur in the posterolateral abdominal wall. Intra-peritoneal or extra-peritoneal contents typically protrude through defects in one of two anatomical triangles. The superior lumbar triangle (Grynfeltt-Lesshaft triangle) is an inverted triangle bordered by the 12th rib superiorly, the internal oblique muscle laterally, and the erector spinae muscle medially. The inferior lumbar triangle (Petit\'s triangle) is an upright triangle bordered by the iliac crest inferiorly, the external oblique muscle laterally, and the latissimus dorsi muscle medially. Surgical repair has been described via open or laparoscopic approach. A 69-year-old male patient presented with right flank pain and swelling. He was involved in a motorcycle accident 10 months prior, which likely resulted in the development of a traumatic lumbar hernia which was demonstrated on the CT scan. The hernia was clinically incarcerated, and the defect contained the cecum and ileocecal valve. The defect was noted just superior to the iliac crest, by definition, making this an inferior lumbar hernia or a Petit\'s hernia. The hernia was repaired via robotic-assisted laparoscopic transabdominal approach. A peritoneal flap was created exposing the fascial defect. The fascia was primarily repaired with suture. The defect was reinforced with an 11.4 cm round Ventralight ST mesh in the preperitoneal space. The patient tolerated the procedure well with no acute complications. He was discharged the same day as an outpatient with appropriate pain control. Short-term follow-up demonstrated no recurrent hernia present and symptoms resolved. Lumbar hernias are a rare occurrence with no gold standard technique for repair. The benefits of the laparoscopic approach have been described over the open approach. This case report describes utilizing a minimally invasive approach to primarily repair a lumbar hernia defect while also reinforcing the hernia with mesh in the preperitoneal space.