Laparoscopic Transabdominal Lumbar Hernioplasty: Main Technical Steps and Mesh Fixation With Cyanoacrylate

Background Mesh atraumatic fixation for hernia repair avoids tissue damage, reducing the risk of bleeding and acute postoperative pain. The objective of this video is to describe the main steps of the laparoscopic transabdominal repair of a primary lumbar hernia, focusing on the mesh fixation with cyanoacrylate. Method A 66-year-old woman (BMI 34 kg/m2) presenting with a 7 cm. lipomatous right lumbar tumor, which causes mild discomfort and occasionally changes in size with movement. CT and MRI confirmed upper lumbar hernia of 7 × 6 cm (Grynfelt hernia). Surgical technique Patient in supine decubitus with marked left lateralization. The procedure was performed using three trocars. The parietal peritoneum is opened, identifying a 3 cm. hernia defect containing perirenal fat. After widening the space, a 15 × 10 cm. PVDF mesh (Endolap 3D® Dynamesh), is placed in an extraperitoneal fashion and fixed with a double crown of cyanoacrylate drops (Glubran®). Once the proper hemostasis was verified, reperitonization was completed and the 12 mm trocar was sutured to minimize the risk for herniation. Any drain was used. Results Operating time: 70 minutes (performed on an outpatient basis) Postoperative period was uneventful. Maximum postoperative pain VAS: 2/10. The patient remains asymptomatic, with no bulging or recurrence on CT scan after 12-months follow-up. The patient satisfaction was high (score: 10/10). Conclusion Lumbar hernia can be treated successfully and efficiently by minimally invasive approach. Mesh fixation with cyanoacrylate is safe and reduces the risk of hemorrhage and acute postoperative pain, facilitating outpatient procedures.