Laparoscopic Repair of an Isolated Congenital Bilateral Lumbar Hernia in an Infant

Abstract

We describe the laparoscopic repair of an isolated congenital bilateral lumbar hernia in an infant. Initial laparoscopic primary repair with nonabsorbable interrupted sutures resulted in recurrence, but subsequent laparoscopic mesh repair led to satisfying results. A lumbar hernia is defined as the protrusion of an organ or tissue through a defect in the posterolateral abdominal wall. This type of hernia is extremely rare. In 1774, Petit reported a patient with a strangulated lumbar hernia. He also described the anatomical borders of the (inferior) lumbar triangle through which the hernia protruded.1 Although he was not the first to publish on this subject, the inferior triangle and the associated hernia are nowadays associated with Petit. Nearly a century later, in 1866, the existence of a superior lumbar triangle was reported by Grynfeltt.2 The inferior lumbar triangle (Petit) is an upright triangular space. Its boundaries are the posterior border of the external oblique muscle anteriorly, the anterior border of the latissimus dorsi muscle posteriorly and the iliac crest inferiorly. Its roof is the superficial fascia and its floor the internal oblique muscle. The superior lumbar triangle (Grynfeltt) is an inverted triangular space. Its borders consist of the posterior border of the internal oblique muscle anteriorly, the anterior border of the sacrospinalis muscle posteriorly, and the 12th rib and serratus posterior inferior muscle superiorly. The roof is formed by the latissimus dorsi muscle and the floor by the aponeurosis of the transversus abdominis muscle.3 In 2007, Moreno-Egea et al estimated that 300 cases of lumbar hernia, protruding through the inferior or superior lumbar triangles, have been reported in the medical literature.4 Approximately 80% of these hernias are considered to be acquired (i.e., incisional or postinfectious) while 20% are thought to be congenital.5 Consistent with these findings, in 2008, Akcora et al reported that a total of 60 congenital hernias have been described.6 In 20 cases, the congenital hernias were associated with the lumbocostovertebral syndrome.7–9 This syndrome includes hemivertebrae, absence of ribs, anterior myelomeningocele, and abdominal wall muscular hypoplasia. Other abnormalities associated with congenital lumbar hernia have been described as well. However, no additional anomalies were found in our patient. Isolated bilateral congenital hernia and open repair in an infant have been described before for the first and, to our knowledge, only time in 2002.10 Here, we report for the first time the laparoscopic repair of this type of bilateral hernia in a baby.