Laparoscopic repair of a lumbar hernia: report of a case and extensive review of the literature
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.
KeywordsHernia Lumbar hernia Laparoscopy Prosthetic mesh
Dr. Juan Hernandez and Sebastian Suarez have no conflict of interest or financial ties to disclose.
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- 1.Jeannel M (1903) La hernie lombaire. Arch Prov Chir Paris 11:389–418Google Scholar
- 3.Garangeot RJ (1731) Colon traite d’operation. Chirurgie 1:369–370Google Scholar
- 4.Stamatiou D, Skandalakis JE, Skandalakis LJ et al (2009) Lumbar hernia: surgical anatomy, embryology, and technique of repair. Am Surg 75:22–207Google Scholar
- 5.Petit JL (1774) Traité des maladies chirurgicales, et des operations qui leur conviennent. Paris: TF Didot 2:256–259Google Scholar
- 7.Grynfeltt J (1866) Quelques mots sur la hernie lombaire. Montp Med 16:323Google Scholar
- 17.Swartz WT (1954) Lumbar hernias. J Ky Med Asssoc 52:673–678Google Scholar
- 19.Watson LE (1948) Hernia, 3rd edn. Mosby, St Louis, pp 443–446Google Scholar
- 26.Sharma, Lt Col P (2009) Lumbar hernia. MJAFI 65:178–179Google Scholar
- 30.Lillie GR, Deppert E (2010) Inferior lumbar triangle hernia as a rarely reported cause of low back pain: a report of 4 cases. JCM 9:73–76Google Scholar
- 31.Moreno-Egea A, Torralba JA, Morales G, Fernández T, Guzmán P, Hita G, Girela W, Corral M, Campillo A, Aguayo JL (2005) Reparación laparoscópica de las hernias lumbares secundarias: cirugía abierta frente a laparoscópica. Estudio prospectivo no aleatorizado. Cir Esp 77:159–162PubMedCrossRefGoogle Scholar
- 33.Rondón JA, Fernández R, Gómez A, Aguilar LC (2002) Hernia lumbar de Grynfelt-Lesshaft. A propósito de 2 casos. Rev Cubana Cir 41:124–128Google Scholar