Grynfeltt Lumbar Hernia Treated by Minilaparoscopy

Grynfeltt Lumbar Hernia Treated by Minilaparoscopy

Diego Laurentino/L Lima, MD; Gustavo L. Carvalho, MD, PhD; Raimundo H. M. Furtado, MD; Gustavo H. Belarmino Goes (Medical Student)

University of Pernambuco


Objective: We describe the treatment of a Grynfeltt hernia by a minilaparoscopic technique.

Case Report/ Surgical Technique: A 62 year old male patient with no history of abdominal surgery. A left lumbar herniation appeared two years ago with no other symptoms. Patient denied any trauma that could be associated with the appearance of the hernia. Physical examination showed a 5cm mass on the left lumbar region, which was confirmed by an ultrasound. Patient was positioned in the left lateral decubitus. The procedure started by configuring the pneumoperitoneum using the semi-open trans umbilical technique and a 10mm trocar was inserted in the umbilical region for the optics. A small incision was created in the left iliac region and a 3mm minilaparoscopic trocar was inserted in the preperitoneal region. The dissection was performed with blunt forceps between the peritoneum and the muscle-aponeurotic layer under laparoscopic visualization. Another 3mm trocar was inserted more dorsally in the anterior region to facilitate bimanual dissection of the preperitoneal space. The umbilical trocar was removed and reintroduced using the same incision in the preperitoneal space created by blunt dissection, using a Foley catheter to close the peritoneal umbilical orifice and to avoid any gas loss in the case of perforation of the peritoneum. The adhesions of the hernia sac were released until they could be reduced, using blunt dissectors and monopolar electrocautery. The polypropylene mesh was placed in the preperitoneal space without need for fixation.

Conclusion: Minilaparoscopic approach was a safe and effective technique for this procedure.