To investigate the clinical efficacy of laparoscopic mesh repair via different surgical approaches for the treatment of lumbar hernia.

A retrospective analysis was performed on the clinical data of four patients with lumbar hernia who underwent laparoscopic surgery at the 901st Hospital of the Joint Logistics Support Force of the PLA between May 2015 and May 2021. Two patients underwent laparoscopic trans-abdominal partial extra-peritoneal (TAPE), while the remaining two received laparoscopic retroperitoneal totally extraperitoneal surgery (R-TEP). The therapeutic outcomes of different laparoscopic approaches were evaluated.

All four patients successfully completed surgery. The operative time was 70 minutes for both patients who received TAPE, while that for the 2 R-TEP patients was 95 minutes and 170 minutes (bilateral case), respectively. The visual analog scale (VAS) pain scores at 24 and 48 hours postoperatively were 4, 3 points and 3, 2 points for the 2 TAPE patients, and 2, 2 points and 1 point(for case 3, the patient was discharged within 48 hours after surgery, and the corresponding measurement was not conducted) for the 2 R-TEP patients, respectively. The postoperative hospital stay was 5 days for both TAPE patients, compared with 1 day and 2 days for the R-TEP patients. The time to first postoperative flatus was 2 days in both TAPE patients and 1 day in both R-TEP patients. No complications such as fever, operative-site hematoma or incision infection were observed. Postoperative pain in all patients resolved within 3 months. During a follow-up period of 36-84 months, no activity limitation or hernia recurrence was reported.

Both surgical approaches are effective in the treatment of lumbar hernia. Laparoscopic R-TEP may be more minimally invasive, associated with faster postoperative recovery and lower costs, but further research and verification are still required.