Hernia Lumbar de la Pared Abdominal: Abordaje Quirúrgico en la Ausencia de un Método Estándar

Introduction: Posterior lumbar hernias following laparoscopic nephrectomy are rare, typically occur in patients with obesity, diabetes, and lack of rehabilitation, and there is no established standard for their repair. Case Presentation: A 75-year-old man with a body mass index of 35.9, stage IIIa chronic kidney disease, hypertension, and type II diabetes presented six months after a left laparoscopic nephrectomy with a painful protrusion in the lumbar region. Computed tomography demonstrated a 5.6 cm fascial defect containing a 600 cc hernia sac with the descending colon. Surgical Technique: Under general anesthesia and in the left lumbotomy position, an extensive retromuscular (“sandwich”) dissection was performed. A preperitoneal polypropylene mesh was secured with four subfascial 1-Prolene sutures. The defect was closed without tension using tension-relieving sutures and a Jackson-Pratt drain. A second onlay mesh with at least a 3 cm overlap was then applied, and a supraaponeurotic drain was placed. Results: The patient tolerated the procedure well, was discharged 48 hours postoperatively, and the drains were removed at two weeks without infection or seroma formation. At 3, 6, and 9 months of follow-up, there was no recurrence, pseudohernia, neuropraxia, or chronic pain, and he had returned to his usual activities. Conclusion: The “sandwich” repair using preperitoneal and onlay mesh in conjunction with closed drainage is a safe and effective option for post-nephrectomy lumbar hernias. Prospective long-term studies are needed to validate its reproducibility and durability.