Editing Lumbar hernia (section)

== '''Technique''' ==

* Open
** Prone
** Incise over mass, at least 2cm below 12th rib, parallel to intercostal nerves
** Reduce sac, open if indicated
** Invaginate sac with absorbable
** Close transversalis fascia
** Synthetic mesh secured to surrounding muscle layers
** Cover mesh with overlying muscle
** Larger defects may require rotational flap repair
* Laparoscopic
** 45 degree decubitus position (see diagram below)
** Umbilical entry
** 5mm ports in ipsilateral upper and lower quadrants
** Reduce sac, reapproximate muscle layers with transfascial suturing device
** IPOM
*** 3-5cm mesh coverage
** TAPP 
*** Three-sided peritoneal flap raised starting 5-7cm anteriorly from the hernia defect




^rotational flap for inferior lumbar hernia using gluteal fascia

[[Category:Abdo wall and retroperitoneum]]