Abstract
Purpose
Congenital lumbar hernia is defined as the protrusion of intraperitoneal or extraperitoneal viscera through a defect of the posterior abdominal wall, present at birth. The aim of our study was to perform a systematic review of this rare pathology, with emphasis on surgical decision-making.
Methods
The English literature (2000–2020) was reviewed, using PubMed, EMBASE and GoogleScholar databases, combining the terms “hernia”, “lumbar”, “flank”, “Grynfeltt”, “Petit” and “congenital”. Overall, 35 studies were included, describing 85 patients.
Results
Mean age was 9.7 ± 20.7 months (range 1 day–10 years). 55.7% were males and 44.3% were females. All patients presented electively, with flank bulging as the main symptom. Superior lumbar triangle (Grynfeltt) herniae accounted for 41.8%, inferior lumbar triangle (Petit) herniae for 32.8%, whereas 25.4% were classified as diffuse. A left-sided hernia was observed in 47%, a right-sided in 42.4%, while 10.6% were bilateral. 71.8% of the patients had associated anatomical anomalies, mainly the lumbocostovertebral syndrome. Most patients (83.3%) were treated surgically, while 16.7% conservatively with surveillance. In 93.3%, the surgical approach was open, with laparoscopy employed in 6.7% of cases. The majority (71.7%) underwent primary suture repair of the hernia defect, whereas a mesh was required in 28.3%. Post-operative morbidity was 6.7% and recurrence rate was 3.3% at a mean follow-up of 26.4 months.
Conclusion
Congenital lumbar hernia is a rare pathology in the paediatric population, with only 85 cases reported since 2000. Although the diagnosis is frequently straightforward, it should raise the suspicion for associated congenital anomalies and further investigation is required, with cross-sectional imaging. Surgical repair is usually performed during the first year, to allow for symmetrical torso development.
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References
Stamatiou D, Skandalakis JE, Skandalakis LJ, Mirilas P (2009) Lumbar hernia: surgical anatomy, embryology, and technique of repair. Am Surg 75:202–207. https://doi.org/10.1177/000313480907500303
Macchi V, Porzionato A, Morra A et al (2017) The triangles of Grynfeltt and Petit and the lumbar tunnel: an anatomo-radiologic study. Hernia 21:369–376. https://doi.org/10.1007/s10029-016-1509-3
Cavallaro G, Sadighi A, Paparelli C et al (2009) Anatomical and surgical considerations on lumbar hernias. Am Surg 75:1238–1241. https://doi.org/10.1177/000313480907501217
Moreno-Egea A, Baena EG, Calle MC et al (2007) Controversies in the current management of lumbar hernias. Arch Surg 142:82–88
Cavallaro G, Sadighi A, Miceli M et al (2007) Primary lumbar hernia repair: the open approach. Eur Surg Res 39:88–92. https://doi.org/10.1159/000099155
Stroup DF, Berlin JA, Morton SC et al (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 283:2008–2012. https://doi.org/10.1001/jama.283.15.2008
Rattan KN, Agarwal A, Dhiman A, Rattan A (2016) Congenital lumbar hernia: a 15-year experience at a single tertiary centre. Int J Pediatr 2016:1–4. https://doi.org/10.1155/2016/7162475
Wakhlu A, Wakhlu AK (2000) Congenital lumbar hernia. Pediatr Surg Int 16:146–148. https://doi.org/10.1007/s003830050048
Sharma A, Pandey A, Rawat J et al (2012) Congenital lumbar hernia: 20 years’ single centre experience. J Paediatr Child Health 48:1001–1003. https://doi.org/10.1111/j.1440-1754.2012.02581.x
Sengar M, Manchanda V, Mohta A et al (2011) Intercostal variant of lumbar hernia in lumbocostovertebral syndrome: our experience with 6 cases. J Pediatr Surg 46:1974–1977. https://doi.org/10.1016/j.jpedsurg.2011.05.010
Touloukian RJ (1972) The lymbocostovertebral syndrome: a single somatic defect. Surgery 71(2):174–181 (PMID: 5057828)
Vagholkar K, Dastoor K (2013) Congenital lumbar hernia with lumbocostovertebral syndrome: a case report and review of the literature. Case Rep Pediatr 2013:1–4. https://doi.org/10.1155/2013/532910
Pristavu AI, Furnica C, Ifrim MM, Popovici RM (2017) Early prenatal diagnosis of a lumbo-costo-vertebral syndrome. J Med Ultrason 45(2):353–355. https://doi.org/10.1007/s10396-017-0827-0
Frías JL, Frías JP, Frías PA, Martínez-Frías ML (2007) Infrequently studied congenital anomalies as clues to the diagnosis of maternal diabetes mellitus. Am J Med Genet Part A 143A:2904–2909. https://doi.org/10.1002/ajmg.a.32071
Stevens CA, Hogue JS, Hopkin RJ et al (2018) Congenital lumbar hernia—a feature of diabetic embryopathy? Am J Med Genet Part A 176:2243–2249. https://doi.org/10.1002/ajmg.a.40381
Eshetu B, Mekonnen T, Berhane M (2019) Lumbo-costo-vertebral syndrome with congenital lumbar hernia: case report. Ethiop J Health Sci 29:413–416. https://doi.org/10.4314/ejhs.v29i3.15
Garg CP, Sharma P, Patel G, Malik P (2011) Sutureless meshplasty in lumbar hernia. Surg Innov 18:285–288. https://doi.org/10.1177/1553350610397214
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Tasis, N., Tsouknidas, I., Antonopoulou, M.I. et al. Congenital lumbar herniae: a systematic review. Hernia 26, 1419–1425 (2022). https://doi.org/10.1007/s10029-021-02473-x
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DOI: https://doi.org/10.1007/s10029-021-02473-x