VCOM Research Day Program Book 2023

Medical Resident Research Case Reports

16 Transabdominal Extraperitoneal Robotic Lumbar Hernia Repair with Fibrin Glue Fixation of Prosthetic Mesh

Hunter Belanger, DO, PGY1; Dominique Dempah, MD

LewisGale Medical Center, Salem

This case describes a transabdominal extraperitoneal robotic lumbar hernia repair using fibrin glue fixation of a prosthetic mesh. The case was documented as it is an uncommon hernia repair, with literature stating only 300 previous documented cases (Beffa, Margiotta, and Carbonell, 2018). This type of hernia can often be misdiagnosed. More commonly seen are inguinal, umbilical, and incisional hernias. This particular case was in a patient who was status-post lumbar fusion. Additionally, the presentation documents relevant anatomy in a retroperitoneal dissection needed to access the hernia space. This hernia can be fixed either open or laparoscopically. In this case the hernia was fixed using robotic laparoscopy. The port placement and patient positioning for robotic approach to this case is described within the report. Also emphasized is the method of mesh fixation. Mesh fixation was accomplished through fibrin glue application as opposed to suture fixation in order to gain better approximation, given the curvature of the lumbar region. Of note, the case also included 2-year post-op imaging with a CT which was obtained for reasons unrelated to the lumbar hernia. The post-op imaging showed no recurrence of the lumbar hernia.

Reference Beffa, L. R., Margiotta, A. L., & Carbonell, A. M. (2018). Flank and lumbar hernia repair. Surgical Clinics, 98(3), 593-605.

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