title: Transperitoneal preperitoneal laparoscopic lumbar incisional herniorrhaphy.
abstract: OBJECTIVE
  Flank incisions may be associated with flank hernias, which may be complicated by incarceration and strangulation. Furthermore, they may be the cause of significant patient dissatisfaction with the surgical outcome. To avoid an open surgical procedure with its associated morbidity for hernia repair we describe a novel laparoscopic technique for repairing flank hernias with minimal morbidity and an excellent outcome.
  
  
  METHODS
  Three cases of flank hernia were managed by the transperitoneal preperitoneal laparoscopic approach using polypropylene mesh to repair the fascial defect. An initial transperitoneal approach helps to identify the limits of the hernia. A 2 to 3 cm. margin of overlying peritoneum is incised around the hernia margin. It is important not to dissect overlying bowel. The mesh is placed behind the peritoneal envelope and secured with hernia staples.
  
  
  RESULTS
  All cases were managed successfully via laparoscopy. There were no intraoperative or postoperative complications. At a mean followup of 12 months cosmesis has been excellent and there have been no recurrences.
  
  
  CONCLUSIONS
  We describe a minimally invasive, versatile technique for laparoscopic repair of flank incisional hernias with excellent functional and cosmetic results. This approach avoids the significant morbidity associated with open repair of incisional flank hernias.
authors.affiliation: Department of Urology, School of Medicine, University of California-San Francisco, 94143-0738, USA.
authors.forename: B
authors.initials: B
authors.lastname: Shekarriz
authors.forename: T M
authors.initials: TM
authors.lastname: Graziottin
authors.forename: S
authors.initials: S
authors.lastname: Gholami
authors.forename: H F
authors.initials: HF
authors.lastname: Lu
authors.forename: H
authors.initials: H
authors.lastname: Yamada
authors.forename: Q Y
authors.initials: QY
authors.lastname: Duh
authors.forename: M L
authors.initials: ML
authors.lastname: Stoller
mesh_terms: D000328:Adult; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010537:Peritoneum; D011183:Postoperative Complications / Q000601:surgery*; D013526:Surgical Mesh