Simultaneous Laparoscopic Repair of Iatrogenic Lumbar and Inguinal Hernias Using Combined TAPP and IPOM: A Case Report.

INTRODUCTION

A lumbar hernia, an exceptionally rare abdominal wall defect, accounts for only 1.5-2% of all reported hernia cases. An inguinal hernia is most common type in adults. The simultaneous occurrence of these two distinct hernias is extremely uncommon; only a few cases have been documented to date. Herein, we report a rare case of concomitant iatrogenic lumbar hernia and indirect inguinal hernia that was successfully repaired in a single session using a combined laparoscopic approach.

CASE PRESENTATION: A 74-year-old Japanese woman presented with a bulge and pain in the left flank and swelling in the left inguinal region 1 year following lumbar spinal surgery with bone graft harvesting from the left iliac crest. Computed tomography revealed an intestinal herniation above the left iliac crest and an omental herniation in the left inguinal region. Laparoscopic exploration confirmed a 6 cm × 7 cm lumbar defect containing the sigmoid colon and an indirect inguinal hernia. The lumbar hernia was repaired using a Symbotex™ Composite Mesh (20 cm × 15 cm; Medtronic, Minneapolis, MN, USA) fixed with absorbable tacks, and the inguinal hernia was repaired with a Bard® 3D Max® mesh (M size; Davol, Warwick, RI, USA) using the transabdominal preperitoneal (TAPP) approach. The total operative time was 120 min, and the postoperative course was uneventful. The patient was discharged on postoperative day 4.

CONCLUSIONS

This case demonstrates the technical feasibility and safety of simultaneous laparoscopic repair of iatrogenic lumbar and inguinal hernias using a combination of intraperitoneal onlay mesh (IPOM) and TAPP techniques. This strategy facilitates minimally invasive, effective, and simultaneous repair under a single anesthesia and hospitalization, highlighting the versatility of laparoscopic surgery in managing complex abdominal wall hernias.