Surgical Endoscopy

, Volume 27, Issue 9, pp 3421–3429 | Cite as

Laparoscopic repair of a lumbar hernia: report of a case and extensive review of the literature

  • Sebastian Suarez
  • Juan D. HernandezEmail author


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.


Hernia Lumbar hernia Laparoscopy Prosthetic mesh 



Dr. Juan Hernandez and Sebastian Suarez have no conflict of interest or financial ties to disclose.

Supplementary material

Supplementary material 1 (MPG 147050 kb)


  1. 1.
    Jeannel M (1903) La hernie lombaire. Arch Prov Chir Paris 11:389–418Google Scholar
  2. 2.
    Goodman EH, Speese J (1916) Lumbar hernia. Ann Surg 63:548–560PubMedCrossRefGoogle Scholar
  3. 3.
    Garangeot RJ (1731) Colon traite d’operation. Chirurgie 1:369–370Google Scholar
  4. 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. 5.
    Petit JL (1774) Traité des maladies chirurgicales, et des operations qui leur conviennent. Paris: TF Didot 2:256–259Google Scholar
  6. 6.
    Heniford BT, Iannitti DA, Gagner M (1997) Laparoscopic inferior and superior lumbar hernia repair. Arch Surg 132:1141–1144PubMedCrossRefGoogle Scholar
  7. 7.
    Grynfeltt J (1866) Quelques mots sur la hernie lombaire. Montp Med 16:323Google Scholar
  8. 8.
    Selby CD (1906) Direct abdominal hernia of traumatic origin. JAMA 47:1485CrossRefGoogle Scholar
  9. 9.
    Kretchmer HL (1951) Hernia of the kidney. J Urol 65:944–949PubMedGoogle Scholar
  10. 10.
    Payne DD, Resnicoff States JD et al (1973) Seat belt abdominal wall muscular avulsion. J Trauma 13:262–267PubMedCrossRefGoogle Scholar
  11. 11.
    McCarthy MC, Lemmon GW (1996) Traumatic lumbar hernia: a SEAT belt injury. J Trauma 40:121–122PubMedCrossRefGoogle Scholar
  12. 12.
    Burick AJ, Parascandola S (1996) Laparoscopic repair of a traumatic lumbar hernia: a case report. J Laparoendoscop Surg 6:259–262CrossRefGoogle Scholar
  13. 13.
    Moreno-Egea A, Baena EG, Calle MC (2007) Controversies in the current management of lumbar hernias. Arch Surg 142:82–88PubMedCrossRefGoogle Scholar
  14. 14.
    Loukas M, Tubbs RS, El-Sedfy A, Jester A, Polepalli S, Kinsela C, Wu S (2007) The clinical anatomy of the triangle of Petit. Hernia 11:441–444PubMedCrossRefGoogle Scholar
  15. 15.
    Loukas M, El-Zammar D, Shoja MM et al (2008) The clinical anatomy of the triangle of Grynfeltt. Hernia 12:227–231PubMedCrossRefGoogle Scholar
  16. 16.
    Cavallaro G, Sadighi A, Paparelli C (2007) Anatomical and surgical considerations on lumbar hernias. Arch Surg 142:82–88CrossRefGoogle Scholar
  17. 17.
    Swartz WT (1954) Lumbar hernias. J Ky Med Asssoc 52:673–678Google Scholar
  18. 18.
    Thorek M (1950) Lumbar hernia. J Int Coll Surg 14:367–393PubMedGoogle Scholar
  19. 19.
    Watson LE (1948) Hernia, 3rd edn. Mosby, St Louis, pp 443–446Google Scholar
  20. 20.
    Barden BE, Maull KI (2000) Traumatic lumbar hernia. South Med J 93:1067–1069PubMedGoogle Scholar
  21. 21.
    Burt BM, Afifi HY, Wantz GE et al (2004) Traumatic lumbar hernia: report of cases and comprehensive review of the literature. J Trauma 57:1361–1370PubMedCrossRefGoogle Scholar
  22. 22.
    Shuhaiber J, Dunn T, Evans A (2003) Traumatic lumbar hernia with ureteropelvic junction disruption: case report and review of the literature. J Trauma 55:985–988PubMedCrossRefGoogle Scholar
  23. 23.
    Salameh JR, Salloum EJ (2004) Lumbar incisional hernias: diagnostic and management dilemma. JSLS 8:391–394PubMedGoogle Scholar
  24. 24.
    Reggio E, Sette MJ, Lemos R et al (2010) Lumbar hernia following percutaneous nephrolithotomy. Clinics 65(10):1061–1062PubMedCrossRefGoogle Scholar
  25. 25.
    Zhou X, Nve JO, Chen G (2004) Lumbar hernia: clinical analysis of 11 cases. Hernia 8:260–263PubMedCrossRefGoogle Scholar
  26. 26.
    Sharma, Lt Col P (2009) Lumbar hernia. MJAFI 65:178–179Google Scholar
  27. 27.
    Baker ME, Weinerth JL, Andriani RT et al (1986) Lumbar hernia: diagnosis by CT. AJR Am J Roentgenol 148:565–567CrossRefGoogle Scholar
  28. 28.
    Armstrong O, Hamel A, Grignon B et al (2008) Lumbar hernia: anatomical basis and clinical aspects. Surg Rad Anat 30:533–537CrossRefGoogle Scholar
  29. 29.
    Hide IG, Pike EE, Uberoi R (1999) Lumbar hernia: a rare cause of large bowel obstruction. Postgrad Med J 75:231–233PubMedGoogle Scholar
  30. 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. 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
  32. 32.
    Cavallaro G, Sadighi A, Meceli M, Burza A, Carbone G, Cavallaro A (2007) Primary lumbar hernia repair: the open approach. Eur Surg Res 39:88–92PubMedCrossRefGoogle Scholar
  33. 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
  34. 34.
    Grauls A, Lallemand B, Krick M (2004) The retroperitoneoscopic repair of a lumbar hernia of petit. Case report and review of literature. Acta Chir Belg 104:330–334PubMedGoogle Scholar
  35. 35.
    Bickel A, Haj M, Eitan A (1997) Laparoscopic management of lumbar hernia. Surg Endosc 11:1129–1230PubMedCrossRefGoogle Scholar
  36. 36.
    Astarciog lu H, Sökmen S, Atila K, Karademir S (2003) Incarcerated inferior lumbar (Petit’s) hernia. Hernia 7:158–160CrossRefGoogle Scholar
  37. 37.
    Links DJR, Berney CR (2011) Traumatic lumbar hernia repair: a laparoscopic technique for mesh fixation with an iliac crest suture anchor. Hernia 15:691–693PubMedCrossRefGoogle Scholar
  38. 38.
    Meinke AK (2003) Totally extraperitoneal laparoendoscopic repair of lumbar hernia. Surg Endosc 17:734–737PubMedCrossRefGoogle Scholar
  39. 39.
    Madan AK, Ternovits CA, Speck KE, Pritchard FE, Tichansky DS (2006) Laparoscopic lumbar hernia repair. Am Surg 72:318–321PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.School of Medicine, Universidad de los AndesDepartment of Surgery, Hospital Universitario Fundación Santa Fe de BogotaBogotáColombia

Personalised recommendations