On-lay Versus Pre-peritoneal Hernioplasty in Incisional Lumbar Hernia

Lumbar hernia is found as a challenge even in the era of advanced medicine, due to its rarity which complicate its diagnosis and treatment\[1\]. Lumbar hernia is the protrusion of an organ intra-peritoneal or extra-peritoneal tissue through a congenital or acquired defect in the posterolateral abdominal wall\[2\]. Incisional Lumbar hernia is among the types of lumbar hernia that accounts for 25% of cases\[3\]. Post abdominal surgeries, the tissue strength can only regain 80% of its maximum tensile power under perfect conditions. Thus, each abdominal surgery is a predisposing factor for lumbar incisional hernia \[4\] Primary closure of the defect with sutures, has proven to have a high failure rate so the integration of the mesh in hernia repair has significantly flattened the recurrence curve. Taking the advantage of Laplace's law, the mesh aims to reinforce or bridge the defect and distribute the intra-abdominal pressure across the entire synthetic sheet rather than just the defect. \[5\] The two most used mesh placing techniques are on-lay and pre-peritoneal. Each method has its benefits and drawbacks. \[6\] Some surgeons outweigh the on-lay technique to avoid extensive dissection. Thus, it is a faster and easier technique; nevertheless, there are several local wound issues. \[7\] The pre-peritoneal method allows the surgeon to apply the mesh posterior to the fascial plane in front of the peritoneum. The latter technique is gaining popularity with time \[8\]

Literature are deficient in comparing on-lay and pre-peritoneal technique in the repair of incisional lumbar hernia.