Open preperitoneal repair versus laparoscopic totally extraperitoneal repair for primary lumbar hernia: a...

Primary lumbar hernia is a rare lateral abdominal wall hernia with a clinically relevant risk of incarceration and strangulation. Evidence directly comparing open preperitoneal repair and laparoscopic totally extraperitoneal repair (TEP) remains limited. This study aimed to compare perioperative outcomes, early recovery parameters, and postoperative complications between the two surgical approaches.

We conducted a single-center retrospective cohort study of consecutive patients undergoing surgery for primary lumbar hernia between January 2023 and December 2024. Patients received either open preperitoneal repair or TEP. Perioperative outcomes, early recovery parameters, postoperative complications, and recurrence were collected. To account for potential confounding, multivariable-adjusted analyses were performed. Log-transformed linear regression was used for operative time and estimated blood loss, linear regression for 24-hour visual analog scale (VAS) pain score, negative binomial regression for postoperative hospital days, and Firth logistic regression for the composite endpoint of any postoperative complication.

A total of 38 patients were included (open, n = 21; TEP, n = 17). In the unadjusted analysis, TEP was associated with longer operative time (median 60 [50-65] vs. 40 [35-50] min; P = 0.003), lower estimated blood loss (median 5 [3-5] vs. 10 [5-10] mL; P < 0.001), and lower 24-hour pain scores (VAS 2 [1-2] vs. 3 [3-4]; P < 0.001). No intraoperative vascular, nerve, or visceral injuries occurred. Postoperative events were rare; recurrence occurred in 1 open patient and none in the TEP group. In multivariable-adjusted analyses, TEP remained associated with longer operative time (33.7% increase, 95% CI 6.1% to 68.6%; P = 0.020), lower estimated blood loss (48.1% reduction, 95% CI 23.7% to 64.8%; P = 0.002), and lower 24-hour VAS pain scores (adjusted mean difference - 1.46, 95% CI - 2.12 to - 0.80; P < 0.001). No significant differences were observed in postoperative hospital days (IRR 0.74, 95% CI 0.40 to 1.37; P = 0.342) or any postoperative complication (OR 0.61, 95% CI 0.06 to 4.38; P = 0.628).

In this cohort, TEP was associated with reduced early postoperative pain compared with open preperitoneal repair. The estimated blood loss difference (5 mL vs. 10 mL) was statistically significant but of limited clinical relevance. Short-term safety outcomes were comparable between groups. Although TEP required longer operative time, this difference may reflect technical complexity rather than inferiority. Larger prospective studies with longer follow-up are needed to confirm these findings and better define patient selection.