Objective To investigate the clinical efficiency of lumbar hernia repair based on path planning.

Methods The retrospective and descriptive study was conducted. The clinical data of 35 patients with lumbar hernia who were admitted to The First Affiliated Hospital of University of Science and Technology of China from November 2016 to March 2024 were collected. There were 14 males and 21 females, aged (61±8)years. According to preoperative computerized tomography examination of the hernia defect diameter, patients with a defect diameter <4 cm underwent enhan-ced field laparoscopic total extraperitoneal repair (eTEP), patients with a defect diameter of 4-8 cm underwent laparoscopic partial extraperitoneal repair (TAPE), and patients with a defect diameter >8 cm underwent open preperitoneal mesh repair (Sublay). Measurement data with normal distribu-tion were represented as Mean±SD, and comparison of three groups were conducted using the one-way ANOVA or Kruskal Wallis test, and Bonferroni correction was used for pariwise comparison. Measurement data with skewed distribution were represented as M(range). Count data were descri-bed as absolute numbers or percentages, and comparison between groups was conducted using the chi‑square test or Fisher exact probability.

Results (1) Operation conditions. Of 35 patients, there were 15 cases undergoing eTEP, of 7 males and 8 females and 12 cases of left hernia and 3 cases of right hernia, with operation time of (92±44)minutes and the duration of postoperative hospital stay of (5.6±2.8)days. There were 17 cases undergoing TAPE, of 5 males and 12 females and 9 cases of left hernia, 7 cases of right hernia and 1 case of bilateral hernia, with operation time of (114±56)minutes and the duration of postoperative hospital stay of (6.4±3.0) days. There were 3 cases undergoing Sublay, of 2 males and 1 female and 1 case of left hernia and 2 cases of right hernia, with operation time of (150±55)minutes and the duration of postoperative hospital stay of (12.3±7.8)days. There were significant differences in the duration of postoperative hospital stay among the three groups (F=4.83, P<0.05). (2) Follow‑up. All 35 patients were followed up for 40.5(range, 3.0-91.0)days. None of patient underwent postoperative complications such as serous swelling, incision infection, intestinal fistula, intestinal obstruction, or puncture hematoma, and no recurrence of lumbar hernia occurred. One patient who underwent TAPE had postoperative abdominal distension, and was cured by symptomatic treatment. Cases with acute pain within postoperative 3 months were 0, 5, 2 in patients undergoing eTEP, TAPE, Sublay, respectively, showing significant differences among them (χ²=8.69, P<0.05). Results of pariwise comparison showed that there was a significant difference in acute pain within postoperative 3 months between patients undergoing eTEP and Sublay (P<0.05), and there was a significant difference in acute pain within postoperative 3 months between patients undergoing eTEP and TAPE (P<0.05); Cases with chronic pain after postoperative 3 months were 0, 1, 1 in patients undergoing eTEP, TAPE, Sublay, respectively, showing no significant difference among them (χ²=4.00, P>0.05).

Conclusion It is safe and feasible to formulate the surgical method according to the defect diameter of lumbar hernia.