Kugel patch repair of superior lumbar hernias

Abstract

In 1866, Grynfeltt was the first to report a hernia through the superior lumbar triangle, which now bears his name [1]. The superior lumbar triangle is an inverted triangle bounded by the internal oblique muscle anteriorly, the erector spinae muscle posteriorly, and the 12th rib and serratus posterior inferior muscle superiorly, which forms the base of the triangle. The roof is formed by the latissimus dorsi muscle. The floor is consisted of transversalis fascia and the aponeurosis of the transverse abdominis muscle [2]. Of primary lumbar hernia, about 24 % become incarcerated [3] and 18 % will actually be strangulated [4]; therefore, it is recommended that both primary and secondary lumbar hernias be repaired early [5]. Nowadays, there are two main surgical approaches for lumbar hernia repair: the traditional approach, with direct suture or with prosthetic mesh repair, and the laparoscopic (transperitoneal or extraperitoneal) approach. Each approach has advantages and disadvantages [6]. We describe an open repair of primary superior lumbar hernia in three patients with the Kugel patch. The results demonstrate that this procedure is easy and safe and presents good recovery after long-term follow-up. Case reports