A Japanese case report has described the successful single-session minimally invasive repair of two anatomically distinct abdominal wall hernias: an iatrogenic lumbar hernia following iliac crest bone-graft harvesting and an ipsilateral indirect inguinal hernia. This unusual combination presented a technically demanding operative challenge because each defect required a different anatomical approach and mesh placement strategy.
Preoperative computed tomography demonstrated bowel herniation through a sizeable lumbar wall defect measuring approximately 6 × 7 cm, along with omental herniation through the ipsilateral inguinal canal. Careful radiological mapping was used to define the defect margins, evaluate the relationship of the lumbar hernia to the iliac crest, and plan appropriate mesh coverage and trocar positioning.
During laparoscopy, the surgical team performed:
- Intraperitoneal onlay mesh repair (IPOM) for the lumbar hernia
- Transabdominal preperitoneal repair (TAPP) for the indirect inguinal hernia
- Placement of two separate meshes in distinct anatomical planes
- Wide mesh overlap around both defects
- Secure fixation while avoiding injury to bowel, nerves, and nearby bony structures
The combined procedure was completed in approximately 120 minutes. The postoperative course was uncomplicated, and the patient was discharged on the fourth postoperative day.
Technical Significance
Lumbar hernias are uncommon and may occur following trauma, previous surgery, infection, or iliac crest bone-graft harvesting. Their repair can be difficult because of:
- Limited surrounding fascial tissue
- Proximity to the iliac crest and retroperitoneal structures
- Difficulty achieving adequate mesh overlap
- Risk of nerve injury and chronic postoperative pain
- Potential bowel contact with intraperitoneal mesh
- Increased recurrence risk if fixation is inadequate
The reported approach demonstrates that laparoscopy can provide a broad internal view of both defects and allow two different repair techniques to be performed during the same anesthetic session. The TAPP approach permits anatomical preperitoneal repair of the inguinal defect, while IPOM provides access to the posterolateral lumbar defect when an extraperitoneal plane is difficult to create.
Clinical Relevance
For laparoscopic and abdominal wall surgeons, this case supports the selective use of a combined TAPP-plus-IPOM strategy when synchronous inguinal and lumbar hernias are identified. Potential advantages include:
- Avoidance of staged operations
- Reduced cumulative anesthesia exposure
- Comprehensive laparoscopic assessment of the abdominal wall
- Ability to tailor mesh placement to each defect
- Short postoperative recovery
- Reduced surgical trauma compared with extensive open repair
However, this strategy should be individualized. Important considerations include defect size, tissue quality, mesh overlap, fixation near the iliac crest, bowel proximity, contamination risk, chronic pain potential, and the surgeon’s experience with advanced abdominal wall reconstruction.
Key Takeaway
Synchronous lumbar and inguinal hernias can be managed in a single minimally invasive operation using different mesh planes and repair techniques. Careful CT-based planning, appropriate port positioning, adequate mesh overlap, and precise fixation are essential for achieving a safe and durable result.
