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V-022 HYBRID APPROACH E-TEP AND OPEN FOR COMBINED LUMBAR AND MIDLINE HERNIAS


 
 
 To present the case of a 61-year-old woman with a recurrent lumbar incisional hernia L4W3R (EHS Classification) associated with a primary midline hernia, as well as a proposed treatment by combined e-TEP and open approach.
 
 
 
 This is a 61-year-old woman with a personal history of obesity, with an open right nephrectomy and later onlay hernia repair.
 She had a large lumbar eventration with an 11 cm defect (L4W3) associated with a primary midline hernia with rectus diasasis.
 We performed a hybrid e-TEP approach for the midline hernia associated with lumbar open approach to perform a complete repair by reverse-TAR technique.
 
 
 
 The treatment of combined lateral and midline hernias remains controversial. In patients in whom the lateral hernia is the primary hernia, one of the proposed approaches would be to perform a posterior component separation from the lateral defect. This involves performing a reverse transverse abdominis release (reverse-TAR), opening the rectus sheath from the lateral preperitoneal plane.
 In obese patients and with large defects, performing this step can be highly complicated due to the difficulty for correct visualization of the area.
 
 
 
 We propose this combined approach, performing a minimally invasive surgery for the dissection of the midline defect, which allows us to perform in a simpler way later the approach from the side, as well as a better exposure and visualization of the area; thus allowing, despite the technical difficulty, the correct placement of a large mesh, which widely covers all the defects.
