e-TEP TAR IN A L4W3 RIGHT POST NEPHRECTOMY HERNIA

Abstract Video abstract A 58-year-old woman with a history of right nephrectomy and open appendectomy, with a past medical history of chronic abdominal pain and bulging at the level of the nephrectomy scar. A partially reducible 9 cm lateral hernia L3W3 (EHS) was diagnosed. The patient underwent an extended totally extraperitoneal hernia repair on the right side. A 2 cm incision on the epigastrium was made medially to the rectus muscle in order to enter the right homolateral retrorectus space. A dissection balloon was introduced to release this space. A 10 mm and 5 mm were inserted in the right hypocondrium and right iliac fossa respectively. A posterior component separation (TAR) was performed, caudal to cranial. We sectioned the aponeurosis of the transverse muscle (TM), accessing the defect and the preperitoneal space laterally. After the hernia content was introduced to the abdominal cavity, the defect was closed. Finally, a wide pore polypropylene mesh was placed, covering the right retrorectus space with the preperitoneal Bogros/Retzius spaces. Atraumatic fixation with cyanoacrylate was used. An aspiration drainage was placed and removed 24 h after surgery. The patient was discharged the day after, and no complications were reported. In the CT scan 6 months after surgery, the correction of the defect was confirmed and pain and esthetic results were satisfactory.