ABDOMINAL RECONSTRUCTION AND INCISIONAL HERNIA REPAIR AFTER LOMBOTOMY PROCEDURE: CASE REPORT

Abstract

Lumbotomy is an old surgical technique, often used for nephrectomies, and although it is effective, with lower morbidity and good recovery, its late complications are still little discussed in the literature. One of the most relevant complications of abdominal surgery is incisional hernia, responsible for 80% of ventral hernias; however, this postoperative condition is not reported in lateral lumbotomy procedures in the literature. Therefore, this case report contributes to the knowledge about possible adverse outcomes and correction strategies for similar cases. OBJECTIVE: To report a case of abdominal reconstruction and ventral incisional herniorrhaphy that occurred after nephrectomy by lateral lumbotomy. METHODOLOGY: This is a descriptive and observational case report study, through the review of medical records, reports, and exams of a patient who underwent left nephrectomy and developed ventral incisional hernia and left anterolateral bulging. Treatment included muscle plication and abdominoplasty, without the use of mesh. The study was submitted to the UNISA Ethics Committee, with a request for exemption from the informed consent form due to unknown patient address. RESULTS AND DISCUSSION: The patient presented with ventral incisional hernia after lateral lumbotomy, in which the surgical procedure involved plication in two planes of the rectus abdominis and lateral muscles with Prolene, in addition to reconstructive abdominoplasty. The technique was chosen due to the severity of the diastasis and the need for structural reinforcement. Discussions in the literature have shown that lateral lumbotomy involves abdominal muscles that, when sectioned, predispose to weakening of the abdominal wall. The patient's obesity was also possibly an aggravating factor, increasing intra-abdominal pressure and hindering healing. The combination of herniorrhaphy with abdominoplasty, according to recent studies, has demonstrated functional and aesthetic benefits, with lower recurrence rates, as was also the case and proven in this case. CONCLUSION: The ventral incisional hernia observed in this case is an unusual presentation after lateral lumbotomy, justified by the extensive muscle incision and the patient's obesity. Correction with two-plane plication and abdominoplasty proved effective, providing reinforcement to the abdominal wall, aesthetic and functional improvement, and reducing the risk of recurrence. Therefore, it is concluded that the therapeutic combination described is a satisfactory alternative for cases of ventral incisional hernias resulting from lateral lumbotomy in obese patients.