PMC3916800_01
Physical examination and computed tomography findings on admission. (A) Left lower back bulging mass of size 10cm x 6cm (arrows). (B) Abdominal computed tomography demonstrating retroperitoneal fat protruding through the superior lumbar triangle (arrow).
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F1
A physical examination showed a 10cm x 6cm reducible soft mass in his left lower flank area (Figure 1A). Abdominal computed tomography revealed a herniation of abdominal fat, protruding through the superior lumbar triangle defined by his quadratus lumborum muscle, 12th rib and internal oblique muscle (Figure 1B).
Position of three trocars over the anterior axillary line directed toward the bulging mass (M).
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F2
Under the guidance of a 10mm laparoscopic camera, we placed two 5mm working trocars into different sites of the fascia layer (Figure 2).
Intraoperative images of the hernia repair. (A) Detachment of extraperitoneal adipose tissue and exposure of the fascia defect (black arrows) at the initial stage of hernia repair. (B) Securing of polypropylene mesh (arrows) after complete patching of the fascia defect (asterisk).
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F3
We carefully dissected the extraperitoneal space by detaching extraperitoneal adipose tissue from the hernia defect (Figure 3A). Finally, we secured the mesh with autosuture stapler (ProTack 5mm, Covidien, Mansfield MA, USA) to prevent migration (Figure 3B).
Postoperative wound over left flank after application of the single-incision technique.
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F4
Our patient recovered satisfactorily from general anesthesia with a single wound over his left flank (Figure 4).