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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References
Jeannel M (1903) La hernie lombaire. Arch Prov Chir Paris 11:389–418
Goodman EH, Speese J (1916) Lumbar hernia. Ann Surg 63:548–560
Garangeot RJ (1731) Colon traite d’operation. Chirurgie 1:369–370
Stamatiou D, Skandalakis JE, Skandalakis LJ et al (2009) Lumbar hernia: surgical anatomy, embryology, and technique of repair. Am Surg 75:22–207
Petit JL (1774) Traité des maladies chirurgicales, et des operations qui leur conviennent. Paris: TF Didot 2:256–259
Heniford BT, Iannitti DA, Gagner M (1997) Laparoscopic inferior and superior lumbar hernia repair. Arch Surg 132:1141–1144
Grynfeltt J (1866) Quelques mots sur la hernie lombaire. Montp Med 16:323
Selby CD (1906) Direct abdominal hernia of traumatic origin. JAMA 47:1485
Kretchmer HL (1951) Hernia of the kidney. J Urol 65:944–949
Payne DD, Resnicoff States JD et al (1973) Seat belt abdominal wall muscular avulsion. J Trauma 13:262–267
McCarthy MC, Lemmon GW (1996) Traumatic lumbar hernia: a SEAT belt injury. J Trauma 40:121–122
Burick AJ, Parascandola S (1996) Laparoscopic repair of a traumatic lumbar hernia: a case report. J Laparoendoscop Surg 6:259–262
Moreno-Egea A, Baena EG, Calle MC (2007) Controversies in the current management of lumbar hernias. Arch Surg 142:82–88
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 11:441–444
Loukas M, El-Zammar D, Shoja MM et al (2008) The clinical anatomy of the triangle of Grynfeltt. Hernia 12:227–231
Cavallaro G, Sadighi A, Paparelli C (2007) Anatomical and surgical considerations on lumbar hernias. Arch Surg 142:82–88
Swartz WT (1954) Lumbar hernias. J Ky Med Asssoc 52:673–678
Thorek M (1950) Lumbar hernia. J Int Coll Surg 14:367–393
Watson LE (1948) Hernia, 3rd edn. Mosby, St Louis, pp 443–446
Barden BE, Maull KI (2000) Traumatic lumbar hernia. South Med J 93:1067–1069
Burt BM, Afifi HY, Wantz GE et al (2004) Traumatic lumbar hernia: report of cases and comprehensive review of the literature. J Trauma 57:1361–1370
Shuhaiber J, Dunn T, Evans A (2003) Traumatic lumbar hernia with ureteropelvic junction disruption: case report and review of the literature. J Trauma 55:985–988
Salameh JR, Salloum EJ (2004) Lumbar incisional hernias: diagnostic and management dilemma. JSLS 8:391–394
Reggio E, Sette MJ, Lemos R et al (2010) Lumbar hernia following percutaneous nephrolithotomy. Clinics 65(10):1061–1062
Zhou X, Nve JO, Chen G (2004) Lumbar hernia: clinical analysis of 11 cases. Hernia 8:260–263
Sharma, Lt Col P (2009) Lumbar hernia. MJAFI 65:178–179
Baker ME, Weinerth JL, Andriani RT et al (1986) Lumbar hernia: diagnosis by CT. AJR Am J Roentgenol 148:565–567
Armstrong O, Hamel A, Grignon B et al (2008) Lumbar hernia: anatomical basis and clinical aspects. Surg Rad Anat 30:533–537
Hide IG, Pike EE, Uberoi R (1999) Lumbar hernia: a rare cause of large bowel obstruction. Postgrad Med J 75:231–233
Lillie GR, Deppert E (2010) Inferior lumbar triangle hernia as a rarely reported cause of low back pain: a report of 4 cases. JCM 9:73–76
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 77:159–162
Cavallaro G, Sadighi A, Meceli M, Burza A, Carbone G, Cavallaro A (2007) Primary lumbar hernia repair: the open approach. Eur Surg Res 39:88–92
Rondón JA, Fernández R, Gómez A, Aguilar LC (2002) Hernia lumbar de Grynfelt-Lesshaft. A propósito de 2 casos. Rev Cubana Cir 41:124–128
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 104:330–334
Bickel A, Haj M, Eitan A (1997) Laparoscopic management of lumbar hernia. Surg Endosc 11:1129–1230
Astarciog lu H, Sökmen S, Atila K, Karademir S (2003) Incarcerated inferior lumbar (Petit’s) hernia. Hernia 7:158–160
Links DJR, Berney CR (2011) Traumatic lumbar hernia repair: a laparoscopic technique for mesh fixation with an iliac crest suture anchor. Hernia 15:691–693
Meinke AK (2003) Totally extraperitoneal laparoendoscopic repair of lumbar hernia. Surg Endosc 17:734–737
Madan AK, Ternovits CA, Speck KE, Pritchard FE, Tichansky DS (2006) Laparoscopic lumbar hernia repair. Am Surg 72:318–321
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Dr. Juan Hernandez and Sebastian Suarez have no conflict of interest or financial ties to disclose.
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Presented at the SAGES 2012 Annual Meeting, March 7–10, 2012, San Diego, CA.
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Suarez, S., Hernandez, J.D. Laparoscopic repair of a lumbar hernia: report of a case and extensive review of the literature. Surg Endosc 27, 3421–3429 (2013). https://doi.org/10.1007/s00464-013-2884-9
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DOI: https://doi.org/10.1007/s00464-013-2884-9