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Mehrabi S, Yavari Barhaghtalab MJ, Babapour M. Renal pelvis and ureteropelvic junction incarceration in a Grynfeltt-Lesshaft hernia: a case report and review of the literature. BMC Urol 2020; 20:74. [PMID: 32586385 PMCID: PMC7318462 DOI: 10.1186/s12894-020-00626-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 05/05/2020] [Indexed: 11/21/2022] Open
Abstract
Background Grynfeltt–Lesshaft hernia is a kind of lumbar abdominal wall hernia in which clinical presentations may vary from an asymptomatic bulge in the lumbar area to a symptomatic lumbar mass with back pain. It has been accepted to be a rare entity, and incarceration of the kidney through this hernia is shown to be very rare, and very few previous cases have been reported in this regard. We present a case of renal pelvic and ureteropelvic junction incarceration in a Grynfeltt-Lesshaft hernia and provide an overview of the existing literature on it. Case presentation A 76-year-old lady presented to the outpatient clinic with the chief complaint of right flank pain and swelling. Computed tomography (CT) scan of the abdomen was revealed a large herniated sac (60*30 mm) in the upper lumbar triangle with protrusion of retroperitoneal and omental fat, right renal pelvis, ureteropelvic junction and proximal ureter with consecutive hydronephrosis. Herniated retroperitoneal and omental fat was reduced, and closure of the abdominal wall defect was done using retro-muscular Mesh and was fixed to the fascia. The patient was discharged 24 h after the surgery without any complications. Conclusion Kidney herniation through the lumbar triangle is extremely rare, and the diagnosis requires careful clinical evaluation. CT scan is the modality of choice for the assessment. Management through surgery should be done in symptomatic patients.
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Affiliation(s)
- Saadat Mehrabi
- Department of General Surgery, Shahid Beheshti Hospital, Yasuj University of Medical Sciences, Yasuj, Iran
| | | | - Mehdi Babapour
- Department of General Surgery, Shahid Beheshti Hospital, Yasuj University of Medical Sciences, Yasuj, Iran
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AlAli MN, AlShammari SA, Omar WM, Ayesh M, Alawi K. Bilateral Fat Containing Lumbar Hernia: A Case Report and Literature Review. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:1253-1258. [PMID: 31446434 PMCID: PMC6730043 DOI: 10.12659/ajcr.917273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Patient: Female, 84 Final Diagnosis: Bilateral fat containing lumbar hernia Symptoms: Abdominal pain Medication: — Clinical Procedure: — Specialty: Surgery
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Affiliation(s)
- Mohammed N AlAli
- Trauma and Acute Care Surgery Unit, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Sulaiman A AlShammari
- Trauma and Acute Care Surgery Unit, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Walid Mohamed Omar
- Department of Radiology, King Saud University Medical City, King Khalid University Hospital, Riyadh, Saudi Arabia
| | - Mohammed Ayesh
- Department of Radiology, King Saud University Medical City, King Khalid University Hospital, Riyadh, Saudi Arabia
| | - Khalil Alawi
- Trauma and Acute Care Surgery Unit, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Abstract
BACKGROUND Superior lumbar hernia is a rare posterolateral abdominal wall defect and herniation of abdominal contents through the superior lumbar triangle. A lumbar hernia is an unusual defect and only 300 cases of primary lumbar hernias have been reported since the first case report in 1731. To date, most clinicians are usually unfamiliar with the presentation of lumbar hernias, and the diagnosis is often done in a wrong way. CASE REPORT A 55-year-old female patient presented with complaints of right flank pain and swelling on the right lumbar region. On abdominal examination, there was round protruding swelling immediately beneath the 12th rib of the right upper flank area. The swelling was palpable and bowel sound was heard over it. The swelling was easily reducible and protruded when the patient was coughing or straining. The opposite side of the lumbar region was normal, and chest examination was clear and normal. The hematological and urine analysis laboratory findings were normal. DISCUSSION The ultrasound finding revealed the bowel contents within the hernial sac. With the diagnosis of primary acquired superior lumbar hernia, the patient underwent open surgery. The defect was reduced back and repaired using a retro-muscular or sublay prolene mesh (15 cm by 7.5 cm). The patient was discharged at post-operative day four and followed-up for four months. CONCLUSION In conclusion, the diagnosis of lumbar hernias should be considered in all patients presented with complaints of flank pain and swelling in the flank area. In the absence of obvious swelling in the flank region, ultrasound investigation might not establish the diagnosis of lumbar hernias. Hence, ultrasound would be the option to confirm the diagnosis when the swelling is palpable.
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Affiliation(s)
- Alemayehu Gonie Mekonnen
- Department of Nursing, College of Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia,
| | - Kebebe Bekele Gonfa
- Department of Surgery, School of Medicine, Goba Referral Hospital, Madda Walabu University, Bale-Goba, Ethiopia
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van Steensel S, Bloemen A, van den Hil LCL, van den Bos J, Kleinrensink GJ, Bouvy ND. Pitfalls and clinical recommendations for the primary lumbar hernia based on a systematic review of the literature. Hernia 2019; 23:107-117. [PMID: 30315438 PMCID: PMC6394702 DOI: 10.1007/s10029-018-1834-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 10/01/2018] [Indexed: 11/18/2022]
Abstract
PURPOSE The lumbar abdominal wall hernia is a rare hernia in which abdominal contents protrude through a defect in the dorsal abdominal wall, which can be of iatrogenic, congenital, or traumatic origin. Two anatomical locations are known: the superior and the inferior lumbar triangle. The aim of this systematic review is to provide a clear overview of the existing literature and make practical clinical recommendations for proper diagnosis and treatment of the primary lumbar hernia. METHODS The systematic review was conducted according to the PRISMA guidelines. A systematic search in PubMed, MEDLINE, and EMBASE was performed, and all studies reporting on primary lumbar hernias were included. No exclusion based on study design was performed. Data regarding incarceration, recurrence, complications, and surgical management were extracted. RESULTS Out of 670 eligible articles, 14 were included and additional single case reports were analysed separately. The average quality of the included articles was 4.7 on the MINORS index (0-16). Risk factors are related to increased intra-abdominal pressure. CT scanning should be performed during pre-operative workup. Available evidence favours laparoscopic mesh reinforcement, saving open repair for larger defects. Incarceration was observed in 30.8% of the cases and 2.0% had a recurrence after surgical repair. Hematomas and seromas are common complications, but surgical site infections are relatively rare. CONCLUSION The high risks of incarceration in lumbar hernias demand a relatively fast elective repair. The use of a mesh is recommended, but the surgical approach should be tailored to individual patient characteristics and risk factors.
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Affiliation(s)
- S van Steensel
- Department of General Surgery, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - A Bloemen
- Department of General Surgery, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
- Department of Surgery, VieCuri Medical Centre, Venlo, The Netherlands
| | - L C L van den Hil
- Department of General Surgery, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - J van den Bos
- Department of General Surgery, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - G J Kleinrensink
- Department of Neuroscience, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - N D Bouvy
- Department of General Surgery, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.
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Farkas NG, Welman TJP, Ross T, Brown S, Smith JJ, Pawa N. Unusual causes of large bowel obstruction. Curr Probl Surg 2018; 56:49-90. [PMID: 30777150 DOI: 10.1067/j.cpsurg.2018.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 12/10/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Nicholas G Farkas
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
| | - Ted Joseph P Welman
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Talisa Ross
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Sarah Brown
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Jason J Smith
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Nikhil Pawa
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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Huang DY, Pan L, Chen MY, Fang J. Laparoscopic repair via the transabdominal preperitoneal procedure for bilateral lumbar hernia: Three cases report and review of literature. World J Clin Cases 2018; 6:398-405. [PMID: 30283803 PMCID: PMC6163131 DOI: 10.12998/wjcc.v6.i10.398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 06/22/2018] [Accepted: 06/28/2018] [Indexed: 02/05/2023] Open
Abstract
A lumbar hernia is a rare entity, and a bilateral lumbar hernia is much rarer. From May 2015 to October 2017, we treated only three patients with bilateral lumbar hernias. One patient came to the hospital presenting with right-sided abdominal pain, and the other two patients presented with bilateral lumbar masses. The previous bilateral lumbar hernia reported in the literature was repaired by open surgery. The laparoscopic approach via the transabdominal preperitoneal (TAPP) procedure with the self-gripping Parietex ProGrip™ mesh was performed at our center. The laparoscopic repair was conducted by a skilled hernia surgeon, and was successfully performed in the three patients. The patients resumed a semi-liquid diet and had no activity restriction after six hours following the operation. No antibiotics were used after the surgery. The operative times of the three patients were 120 min, 85 min, and 130 min. The blood loss volumes of the three patients were 20 mL, 5 mL, and 5 mL. The visual analogue scale pain scores of the three patients were 1, 2, and 2 on postoperative day 1, and were 1, 2, and 1 on postoperative day 3. No perioperative complications, such as bulge, wound infection and hematoma, occurred after the surgery. All of the patients were discharged on the third day after the operation. There was no chronic pain and no hernia recurrence during the follow-up. This study showed that the laparoscopic TAPP approach with the self-gripping mesh is safe and feasible, and can be considered an alternative method for the treatment of bilateral lumbar hernias.
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Affiliation(s)
- Di-Yu Huang
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Long Pan
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
- Key Laboratory of Laparoscopic Technique Research of Zhejiang Province, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Ming-Yu Chen
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Jing Fang
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
- Key Laboratory of Laparoscopic Technique Research of Zhejiang Province, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
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7
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Suh Y, Gandhi J, Zaidi S, Smith NL, Tan MY, Khan SA. Lumbar hernia: A commonly misevaluated condition of the bilateral costoiliac spaces. TRANSLATIONAL RESEARCH IN ANATOMY 2017. [DOI: 10.1016/j.tria.2017.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
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Park SH, Chung HS, Song SH. Lumbar hernia in South Korea: different from that in foreign literature? Hernia 2014; 19:835-9. [PMID: 25504452 DOI: 10.1007/s10029-014-1333-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 12/02/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE This study aimed to analyze the clinical features of lumbar hernia reported in South Korea and compare these features with those reported in foreign literature. METHODS From January 1968 through December 2013, 13 cases reported in South Korea were included in the study. The variables compared were age, sex, main symptoms at hospital visit, etiology, location, herniated contents, lateralization, defect size, diagnostic methods, surgical methods, surgical opinions, and recurrence. RESULTS In the South Korean cases, women outnumbered men (3.3:1) and no significant differences were found in the herniated side (left:right, 1.1:1). In contrast, in the foreign cases, men outnumbered women (3:1) and left-sided hernia was dominant (2:1). Moreover, in most of the foreign cases, patients were aged 50-70 years, whereas in the South Korean cases, none of the patients were in their 50 s. However, no substantial differences were found in etiology, anatomical locations, symptoms, and herniated contents. CONCLUSION This research revealed that few clinical features of lumbar hernias in South Korea differ from those reported in foreign literature. Thirteen cases were analyzed in the present study, and results obtained from such a small sample size cannot be generalized with certainty. Therefore, more cases should be collected for a definitive analysis. Despite this limitation, this study is important because it is the first attempt to collect and analyze the clinical features of lumbar hernia in South Korea. This study will serve as a basis for future studies investigating the clinical features of lumbar hernia cases in South Korea.
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Affiliation(s)
- S H Park
- Department of Clinical Pharmacy, College of Pharmacy, Chosun University, Gwangju, South Korea
| | - H S Chung
- Department of Surgery, Gwangju Veterans Hospital, 99 Cheomdanwolbong-ro, Gwangsan-gu, Gwangju, South Korea.
- Department of Surgery, College of Medicine, Chosun University, Gwangju, South Korea.
| | - S H Song
- Department of Surgery, Gwangju Veterans Hospital, 99 Cheomdanwolbong-ro, Gwangsan-gu, Gwangju, South Korea
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Fokou M, Fotso P, Ngowe Ngowe M, Essomba A, Sosso M. Strangulated or incarcerated spontaneous lumbar hernia as exceptional cause of intestinal obstruction: case report and review of the literature. World J Emerg Surg 2014; 9:44. [PMID: 25089151 PMCID: PMC4118656 DOI: 10.1186/1749-7922-9-44] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 06/26/2014] [Indexed: 11/10/2022] Open
Abstract
Lumbar hernias are rare conditions and about 300 cases have been reported since the first description by Barbette in 1672. Therefore strangulation or incarceration are also exceptionally encountered. We present a 62 -year-old-man who had strangulated left lumbar hernia and consequent mechanical small-bowel obstruction, alongside with a non strangulated right lumbar hernia. Through a median laparotomy, an intestinal necrosis was found. A bowel resection with end to end anastomosis was performed and the lumbar hernias were repaired on both sides. The recovery was uneventfull. To the best of our knowlwdge thanks to the litterature review presented here, this is the 19th case of incarcerated or strangulated spontaneous lumbar hernia described in the surgical litterature since 1889.
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Affiliation(s)
- Marcus Fokou
- Departement of Surgery, Yaounde General Hospital, POB 5408, Yaounde, Cameroon
| | - Patrick Fotso
- Departement of Surgery, Yaounde General Hospital, POB 5408, Yaounde, Cameroon
| | | | - Arthur Essomba
- Departement of Surgery, Yaounde General Hospital, POB 5408, Yaounde, Cameroon
| | - Maurice Sosso
- Departement of Surgery, Yaounde General Hospital, POB 5408, Yaounde, Cameroon
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10
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Xu T, Zhang S, Wang H, Yu W. Lumbar hernia associated with chronic obstructive pulmonary disease (COPD). Pak J Med Sci 2013. [PMID: 24353649 DOI: 10.12669/pjms.293.3232] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Lumbar hernias are very rare posterolateral abdominal wall hernias, and they are spontaneous in most adult patients. Here we report two cases of spontaneous lumbar hernias associated with chronic obstructive pulmonary disease (COPD). Some factors such as chronic cough, poor nutritional status and old age in patients with COPD would contribute to lumbar hernia.
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Affiliation(s)
- Tao Xu
- Tao Xu, MD, Department of Respiration, The People's Hospital of Yinzhou, The Affiliated Yinzhou Hospital, Ningbo University, 251 Baizhang East Road, Ningbo, Zhejiang, 315040, The People's Republic of China
| | - Shuwei Zhang
- Shuwei Zhang, MD, Department of Urological Surgery, The No.2 Hospital of Yinzhou, 1 Qianhe Road, Ningbo, Zhejiang, 315040, The People's Republic of China
| | - Huaying Wang
- Huaying Wang, MD, PhD, Department of Respiration, The People's Hospital of Yinzhou, The Affiliated Yinzhou Hospital, Ningbo University, 251 Baizhang East Road, Ningbo, Zhejiang, 315040, The People's Republic of China
| | - Wanjun Yu
- Wanjun Yu, MD, PhD, Department of Respiration, The People's Hospital of Yinzhou, The Affiliated Yinzhou Hospital, Ningbo University, 251 Baizhang East Road, Ningbo, Zhejiang, 315040, The People's Republic of China
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11
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Abstract
Lumbar hernia is a rare defect of the abdominal wall. It accounts for 2 % of all wall hernias. It is divided in two levels: superior lumbar hernia, also known as Grynfeltt's hernia (GH), and an inferior lumbar hernia or Petit's hernia. GH is more commonly encountered in practice, and it is mainly posttraumatic in origin. Spontaneous primary GH is quite rare. Only 250 to 300 of such cases have been reported the in literature so far. The treatment of choice is retroperitoneal surgical approach and a meshplasty after complete reduction of its contents. Prognosis is usually excellent.
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12
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Suarez S, Hernandez JD. Laparoscopic repair of a lumbar hernia: report of a case and extensive review of the literature. Surg Endosc 2013; 27:3421-9. [PMID: 23636518 DOI: 10.1007/s00464-013-2884-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Accepted: 02/15/2013] [Indexed: 01/10/2023]
Abstract
Lumbar hernias are a protrusion of intra-abdominal contents through a weakness or rupture in the posterior abdominal wall. They are considered to be a rare entity with approximately 300 cases reported in the literature since it was first described by Barbette in 1672. Petit described the inferior lumbar triangle in 1783 and Grynfeltt described the superior lumbar triangle in 1866; both are anatomical boundaries where 95% of lumbar hernias occur, whereas the other 5% are considered to be diffuse. Twenty percent of lumbar hernias are congenital and the other 80% are acquired; the acquired lumbar hernias can be further classified into either primary (spontaneous) or secondary. The typical presentation of lumbar hernias is a patient with a protruding semispherical bulge in the back with a slow growth. However, they may present with an incarcerated or strangulated bowel, so it is recommended that all lumbar hernias must be repaired as soon as they are diagnosed. The "gold standard" for diagnosing a lumbar hernia is a CT scan, because it is able to delineate muscular and fascial layers, detect a defect in one or more of these layers, evaluate the presence of herniated contents, differentiate muscle atrophy from a real hernia, and serve as a useful tool in the differential diagnosis, such as tumors. Recent studies have demonstrated the advantages of a laparoscopic repair instead of the classic open approach as the ideal treatment option for lumbar hernias. We report a case of a spontaneous lumbar hernia initially diagnosed as a lipoma and corrected with the open approach, but after relapsing 2 years later it was corrected using a laparoscopic approach. It is followed by an extensive review of lumbar hernias literature regarding history, anatomy, and surgical techniques.
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Affiliation(s)
- Sebastian Suarez
- School of Medicine, Universidad de Andes, Department of Surgery, Hospital Universitario Fundación Santa Fe de Bogota, Carrera 7 No 116-05, Cuarto Piso, Bogotá, Colombia
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Petersen K, Snikeris J, Hall TS. Bleichner's hernia - lumbar hernia. AMERICAN JOURNAL OF CASE REPORTS 2013; 14:26-9. [PMID: 23569557 PMCID: PMC3614380 DOI: 10.12659/ajcr.883760] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Accepted: 05/10/2012] [Indexed: 02/04/2023]
Abstract
BACKGROUND We present a case of a lumbar hernia and a review of the literature of this rare hernia type. CASE REPORT The case and the review will discuss the unusual presentations reported, common etiologies, the importance of early operative repair based on the high rate of incarceration and the recent recommendations regarding repair techniques. CONCLUSIONS Lumbar hernias are rare cases, but should be pursued in diagnosis and treated aggressively because of the high rate of incarceration. Repair can be accomplished with a minimally invasive technique.
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Affiliation(s)
- Katherine Petersen
- Department of Surgery, The Stamford Hospital, Columbia University, CT, U.S.A
| | - Jaclyn Snikeris
- Department of Surgery, The Stamford Hospital, Columbia University, CT, U.S.A
| | - Timothy S. Hall
- Department of Surgery, The Stamford Hospital, Columbia University, CT, U.S.A
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Nam SY, Kee SK, Kim JO. Laparoscopic transabdominal extraperitoneal mesh repair of lumbar hernia. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2011; 81 Suppl 1:S74-7. [PMID: 22319745 PMCID: PMC3267072 DOI: 10.4174/jkss.2011.81.suppl1.s74] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Revised: 06/07/2011] [Accepted: 06/09/2011] [Indexed: 12/13/2022]
Abstract
Lumbar hernias are rare posterolateral abdominal wall defects that may be congenital or acquired. There are two types of lumbar hernia, the superior lumbar hernia through Grynfeltt triangle, and the inferior lumbar hernia through Petit triangle. Many techniques have been described for the surgical repair of lumbar hernias including primary repair, local tissue flaps, and conventional mesh repair. But these open techniques require a large skin incision. We report a case of superior lumbar hernia, which was successfully repaired using a laparoscopic approach.
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Affiliation(s)
- Soon Young Nam
- Department of Surgery, CHA University CHA Gumi Medical Center, Gumi, Korea
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15
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Abstract
Lumbar hernias, rarely seen in clinical practice, can be acquired after open or laparoscopic flank surgery. We describe a successful laparoscopic preperitoneal mesh repair of multiple trocar-site hernias after extraperitoneal nephrectomy. All the key steps including creating a peritoneal flap, reducing the hernia contents, and fixation of the mesh are described. A review of the literature on this infrequent operation is presented. Laparoscopic repair of lumbar hernias has all the advantages of laparoscopic ventral hernia repair.
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Affiliation(s)
- Michel Gagner
- Herbert Wertheim College of Medicine, Florida International University, Department of Surgery, Miami, Florida, PO Box 336 H, Scarsdale, NY 10583, USA.
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Light D, Gopinath B, Banerjee A, Ratnasingham K. Incarcerated lumbar hernia: a rare presentation. Ann R Coll Surg Engl 2010; 92:W13-4. [PMID: 20412661 DOI: 10.1308/147870810x12659688851393] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This case illustrates the diagnostic uncertainty seen in lumbar herniation as a rare cause of large bowel obstruction.
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Affiliation(s)
- D Light
- Department of General Surgery, North Tees and Hartlepool NHS Trust, North Tees Hospital, Stockton-on-Tees, UK.
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Stamatiou D, Skandalakis JE, Skandalakis LJ, Mirilas P. Lumbar Hernia: Surgical Anatomy, Embryology, and Technique of Repair. Am Surg 2009. [DOI: 10.1177/000313480907500303] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Lumbar hernia is the protrusion of intraperitoneal or extraperitoneal contents through a defect of the posterolateral abdominal wall. Barbette was the first, in 1672, to suggest the existence of lumbar hernias. The first case was reported by Garangeot in 1731. Petit and Grynfeltt delineated the boundaries of the inferior and superior lumbar triangles in 1783 and 1866, respectively. These two anatomical sites account for about 95 per cent of lumbar hernias. Approximately 20 per cent of lumbar hernias are congenital. The rest are either primarily or secondarily acquired. The most common cause of primarily acquired lumbar hernias is increased intra-abdominal pressure. Secondarily acquired lumbar hernias are associated with prior surgical incisions, trauma, and abscess formation. During embryologic development, weakening of the area of the aponeuroses of the layered abdominal muscles that derive from somitic mesoderm, which invades the somatopleure, may potentially lead to lumbar hernias. Repair of lumbar hernias should be performed as early as possible to avoid incarceration and strangulation. The classic repair technique uses the open approach, where closure of the defect is performed either directly or using prosthetic mesh. The laparoscopic approach, either transabdominal or extraperitoneal, is an alternative.
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Affiliation(s)
- Dimitrios Stamatiou
- Centers for Surgical Anatomy and Technique, Emory University School of Medicine, Atlanta, Georgia
| | - John E. Skandalakis
- Centers for Surgical Anatomy and Technique, Emory University School of Medicine, Atlanta, Georgia
| | - Lee J. Skandalakis
- Centers for Surgical Anatomy and Technique, Emory University School of Medicine, Atlanta, Georgia
| | - Petros Mirilas
- Centers for Surgical Anatomy and Technique, Emory University School of Medicine, Atlanta, Georgia
- 2nd Department of Pediatric Surgery, Aristotle University of Thessaloniki Medical School, Thessaloniki, Greece
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18
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Loukas M, El-Zammar D, Shoja MM, Tubbs RS, Zhan L, Protyniak B, Krutoshinskaya Y. The clinical anatomy of the triangle of Grynfeltt. Hernia 2008; 12:227-31. [DOI: 10.1007/s10029-008-0354-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2007] [Accepted: 02/01/2008] [Indexed: 10/22/2022]
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Ng SSM, Ng NC, Liu SYW, Lee JFY. Radiology for the surgeon. Soft-tissue case 58: incarcerated Grynfeltt hernia. Can J Surg 2006; 49:129-30. [PMID: 16630425 PMCID: PMC3207531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023] Open
Affiliation(s)
- Simon S M Ng
- Department of Surgery, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China.
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