Superior Lumbar Hernia Research Articles

Endoscopic retroperitoneal repair of superior lumbar hernia (Grynfeltt hernia) using self-fixating mesh to prevent nerve injury: a case report

BackgroundThe primary superior lumbar hernia, also called the Grynfeltt Hernia, is a rare entity; hence, a standard surgical repair method has not been established. It is important for this repair procedure not only to prevent recurrence by placing an adequate size of mesh but also to avoid nerve injury. The endoscopic retroperitoneal approach is considered a useful technique for this procedure, requiring no mobilization of the colon and providing good visibility of the surrounding nerves. A self-fixating mesh does not require a traumatic fixation, which is considered advantageous for nerve preservation.Case presentationA 72-year-old woman, complaining of left lumbar swelling, was diagnosed with a primary left superior lumbar hernia and underwent endoscopic retroperitoneal hernia repair. With the patient in the right lateral decubitus position, five small ports were inserted, and the retroperitoneal space was dissected. The 2.0 × 1.0-cm hernial orifice was found, and the 12th subcostal nerve above the hernial orifice and the iliohypogastric and the ilioinguinal nerves below the hernial orifice were identified. A 15 × 10-cm self-fixating mesh was placed in the retroperitoneal space without mesh tacking. The postoperative course was uneventful, and the patient was discharged on the first postoperative day. Two years after surgery, there was no sign of recurrence, and chronic pain and neuropathic symptoms were absent.ConclusionsEndoscopic retroperitoneal repair of primary superior lumbar hernia using a self-fixating mesh seems to be useful for nerve preservation.

Bilateral Grynfeltt lumbar hernia: A rare case report

Lumbar hernias are rare, with only around 300 cases reported in the literature. The posterolateral abdominal wall has two weak areas, the superior (Grynfeltt-Lesshafts triangle) and the inferior (Petits triangle) lumbar triangles, where superior and inferior lumbar hernias can occur. These hernias pose a diagnostic and therapeutic challenge to most surgeons due to their rarity.

Retrospective analysis of 16 cases of lumbar hernia

BackgroundThrough a retrospective analysis of 16 cases of lumbar hernia, we discussed the anatomical basis, clinical manifestations, diagnosis, and treatment of this rare condition. MethodsWe collected medical data of 15 patients with a primary lumbar hernia and one patient with a secondary lumbar hernia treated in the General Surgery Department of Wuxi No.2 People's Hospital between January 2008 and June 2021 and analysed their demographic, preoperative, and postoperative data. ResultsAll patients underwent elective surgery performed by the same treatment team for superior lumbar hernias. The median area of the hernia defect was 12 cm2. Fifteen patients underwent sublay repair, and one underwent onlay repair. The median operative time and blood loss were 48 min and 22 mL, respectively. The hernia contents were extraperitoneal fat in 15 patients and partial small intestine in one. The median visual analogue scale score on postoperative day 1 was 3. A postoperative drainage tube was placed in three cases but not used in 13. The median duration of hospital stay was 5 days. Postoperative incision infection occurred in one case. During the follow-up period, no postoperative complications, including haematoma, seroma, incision infection or rupture, recurrence, and chronic pain, occurred in the other 15 cases. ConclusionLumbar hernias are rare and can be safely and effectively treated by open tension-free repair.

Primary Jean Louis Petit’s Hernia: A Case Report

Lumbar hernia is a rare defect of the abdominal wall. It accounts for 2% of all wall hernias. It is divided in two levels: superior lumbar hernia, also known as Grynfeltt’s hernia (GH), and an inferior lumbar hernia or Petit’s hernia. They are in most of the cases secondary to trauma or previous surgery but primary lumbar hernias are rare. Computed tomography (CT) is a very useful tool for the diagnosis of lumbar hernia. It can delineate the neck of the hernia and hernial contents. We reported a case of 60 years old male parient with primary jean louis Petit’s hernia.

1227 Laparoscopic Repair of a Grynfeltt-Lesshaft Hernia: Case Report

Abstract Background Lumbar hernias are an uncommon presentation, with only 300 cases published to date. The aetiology is variable, and they usually present as palpable masses or swellings in the lumbar region. We present a case of successful laparoscopic transabdominal preperitoneal (TAPP) repair of a lumbar hernia with mesh. Case report A 62-year-old male patient, with a history of sarcoidosis and hypertension, was referred to general surgeons with a symptomatic enlarging swelling in the left lumbar region. Preoperative computed tomography (CT) and Ultrasound revealed a superior lumbar hernia. Intraoperatively a 2cm defect was identified. A small lipoma was present within the defect and excised. The defect was repaired with a 10x15cm SymbotexTM mesh secured with ProtackTM. There were no complications operatively or post-operatively and he was discharged the following day. Discussion Anatomically, the lumbar region is bound by the 12th rib superiorly, the iliac crest inferiorly, erector spinae muscles medially and external oblique laterally. Two defined areas of weakness are the superior (Grynfeltt-Lesshaft’s) and inferior (Petit’s) triangles, the first being more common for hernias and experienced by our patient. Surgical repair is the only definitive management and is recommended due to the significant risk of complications. A therapeutically aimed classification system, such as Mereno-Ageas, can be utilised to decide between open and laparoscopic approaches. Conclusions Lumbar hernias are often misdiagnosed due to their rarity. An in-depth history, clinical examination and use of CT preoperatively will aid diagnosis and guide management. Ultimately management will depend on the individual patient and clinician preferences and experience.

Clinical, surgical characteristics and long-term outcomes of lumbar hernia

Background/AimLumbar hernia is caused by a defect in the abdominal wall. Due to its rarity, there is no established consensus on optimal treatment for lumbar hernia yet. Thus, we here investigated the clinical, surgical characteristics and outcomes of lumbar hernia by collecting 28 such patients from our hospital.MethodsPatients diagnosed with lumbar hernia from our institution between April 2011 and August 2020 were retrospectively collected in this study. Demographics, clinical characteristics and surgical information were recorded.ResultsA consecutive series of 28 patients with lumbar hernia were retrospectively collected, including 13 males (46%) and 15 females (54%). The ages of the patients ranged from 5 to 79 years (median: 55 years), with a mean age of 55.6 ± 14.9 years. A total of 7 cases had a history of previous lumbar trauma or surgery. There were 11 (39%), 15 (54%) and 2 (7.1%) cases had right, left and bilateral lumbar hernia, respectively. Superior and inferior lumbar hernia were found in 25 (89%) and 3 (11%) patients. General anesthesia was adopted in 16 cases (group A), whereas 12 patients received local anesthesia (group B). Patients in the group B had a shorter hospital stay than that of the group A (3.5 ± 1.3 days vs. 7.1 ± 3.2 days, p = 0.001), as well as total hospitalization expenses between the two groups (2989 ± 1269 dollars vs. 1299 ± 229 dollars, p < 0.001). With a median follow-up duration of 45.9 months (range: 1–113 months), only 1 (3%) lumbar hernias recurred for the entire cohort.ConclusionsLumbar hernia is a relatively rare entity, and inferior lumbar hernia is rarer. It is feasible to repair lumbar hernia under local anesthesia.

Retroperitoneal totally endoscopic prosthetic repair of primary lumbar hernia.

A primary lumbar hernia is a rare entity that requires surgical management, but the preferred technique has not been established. We herein describe a standardized and reproducible retroperitoneal totally endoscopic prosthetic (TEP) repair technique for primary lumbar hernias. Ten adult patients with primary lumbar hernias underwent retroperitoneal TEP repair from February 2019 to July 2020. A sufficient retroperitoneal space was established to accommodate a non-coated polypropylene mesh to reinforce the weakened flank area, and hernia content reduction and defect closure were then performed. The patients' clinical data were prospectively collected and analyzed. Nine patients had a primary superior lumbar hernia and one patient had a primary diffuse lumbar hernia. All operations were successfully performed without serious intraoperative complications. The mean defect area was 6.4 ± 2.8cm2 (range 4-12cm2), and the mean mesh area was 144.6cm2 (range 130-180cm2). The average operative time (skin to skin) was 49.0 ± 5.7min (range 40-60min), and intraoperative bleeding was minimal. The mean visual analog pain scale score at rest on the first postoperative day was 2.2 (range 2-3). The average length of postoperative stay was 1.5days (range 1-2days). No serious postoperative complications occurred. No recurrence, chronic pain, or mesh infection occurred during a mean follow-up period of 7.5months. The retroperitoneal TEP repair for primary lumbar hernias is safe, efficient, and reproducible. Anti-adhesive coated meshes and fixation tackers are not required, making this a cost-effective procedure that is worthy of recommendation.

MDCT OF ABDOMINAL WALL LUMBAR HERNIAS

Purpose:To review the anatomical landmarks of the abdominal wall lumbar region and its normal appearance on multidetector computed tomography (MDCT) and to briefly describe the MDCT features of lumbar hernias.Diagnosis of traumatic diaphragmatic hernia due to blunt abdominal trauma requires a high index of suspicion. This study was conducted to assess the accuracy of multidetector computed tomogram (MDCT) in the diagnosis of traumatic diaphragmatic hernia.Diaphragmatic injuries remain a diagnostic challenge for both radiologists and surgeons. The detection of traumatic diaphragmatic rupture in the acute setting is problematic because specific clinical signs are usually not evident. Furthermore, the high frequency of associated injuries (52–100%) may distract from diaphragmatic injury. In conservatively managed patients, the rate of initially missed diaphragmatic injuries ranges from 12 to 66%, and they may even be overlooked at laparotomy. Diagnosis of a diaphragmatic injury requires a high index of suspicion, as delayed diagnosis increases the chance of visceral herniation and strangulation, which has mortality as high as 60%. Thus, the ability to detect diaphragmatic injuries with noninvasive techniques is increasingly important. Initial reports found CT to have sensitivity equal to that of chest radiography (i.e., 0–50%). Because of a dramatic reduction in motion and beam-hardening artifacts and significant improvement of spatial resolution, especially along the z-axis, helical CT and multisection CT allow better demonstration of most subtle signs of diaphragmatic herniation. In addition, these are also useful tools in the evaluation of patients with multiple traumatic injuries. Traumatic diaphragmatic hernias (TDHs) are sometimes difficult to identify at an early stage and can consequently result in diagnostic delays with life-threatening outcomes. It is the aim of this case study to highlight the difficulties encountered with the earlier detection of traumatic diaphragmatic hernias. Methods: We performed a retrospective search of the imaging report database from November 2007 to October 2011. We retrieved the clinical data and MDCT studies of patients suffering from abdominal wall lumbar hernias. We reviewed the imaging features of abdominal lumbar hernias and compared those with the normal appearance of the lumbar region in asymptomatic individuals.We assessed variables such as age, gender, mechanism of trauma, methods of diagnosis, herniated organs and associated lesions, time of evolution, morbidity, and mortality. Anteroposterior supine chest radiograph, which was performed in all patients, was also analyzed. Computed tomogram (CT) was performed on four-slice MDCT after an IV bolus of iodinated contrast agents. A slice thickness of 4 mm at a pitch of 1.5 was useful to evaluate thorax and abdomen with reconstruction at 1 mm reconstruction increment. An oral contrast agent was given whenever required. Multiplanar reconstruction was done in sagittal and coronal planes. Images were read in lung parenchyma, soft tissues, and bone windows. Findings were analyzed in a prospective manner to evaluate their use as a diagnostic modality as well as to determine their contribution to patient management. Results:We classified lumbar wall hernias as diffuse, superior (or Grynfelt–Lesshaft) and inferior (or Petit) lumbar hernias. We briefly describe the imaging features of each subtype and review the anatomy and MDCT appearance of normal lumbar region.Currently available MDCT provides an excellent opportunity for reviewing the normal anatomy of the wall lumbar region and may be considered a useful modality for evaluating lumbar hernias.Regarding Diaphragmatic hernia following blunt trauma:MDCT is a highly accurate modality for diagnosing traumatic diaphragmatic hernia. In addition, it is fast and compatible with various life-support systems hence, it can be used in acute trauma setting for making a diagnosis and helping in the management.Delayed traumatic diaphragmatic hernias are not common, but can lead to serious consequences once occurred. Early detection of diaphragmatic injuries is crucial to prevent the occurrence of dTDHs. Surgeons should maintain a high suspicion for injuries of the diaphragm in patients who had suffered abdominal or lower chest traumas, especially during the initial surgical explorations. The need for radiographical follow-ups is emphasized to detect diaphragmatic injuries at an earlier stage.

Sublay repair for primary superior lumbar hernia with the Kugel patch.

BackgroundA superior lumbar hernia is a posterior ventral hernia that is rarely encountered in the clinical setting. However, no standard operative strategy exists for superior lumbar hernia repair at present.MethodsTwelve patients with primary superior lumbar hernia who underwent sublay repair via the retroperitoneal space with the Kugel patch between December 2008 and June 2019 were included in this study. The demographic, peri‐operative and post‐operative data of the patients were collected to analyse the effectiveness of this technique.ResultsAll patients underwent an uneventful operation. The median operative time was 60 min, and the median blood loss was 35 mL. The median hernia defect area was 16 cm2. Five medium‐sized Kugel patches (11 cm × 14 cm) and seven large‐sized Kugel patches (14 cm × 17 cm) were used for the repairs. The median visual analogue scale score on post‐operative day 1 was 3. The median time to removal of drainage was 3 days. The median duration of the hospital stay was 3 days. No serious post‐operative complications, including seroma, haematoma, incision or mesh infection, recurrence and chronic pain, occurred during the follow‐up period.ConclusionSublay repair for primary superior lumbar hernia with the Kugel patch shows benefits including a reliable repair, minimal invasiveness and few post‐operative complications.

Laparoscopic Transabdominal Repair for Lumbar Hernia: A Familiar Procedure for a Rare Problem

Lumbar hernia is a protrusion of intraperitoneal or extraperitoneal tissues through posterior abdominal wall defect and is considered to be a rare condition. We present a case of 65-year-old lady with primary spontaneous superior lumbar hernia treated laparoscopically, with the detailed operative steps and post-operative follow-up. With the growing experience in laparoscopic inguinal hernia repair, same technique, instruments and device used in transabdominal preperitoneal (TAPP) repair can be applied to treat selected cases of lumbar hernia with good outcome.

A case report and review of lumbar hernia

The lumbar area is limited by the bone structures (superiorly by the 12th rib and inferiorly by the iliac crest); furthermore, several important nerves including the genitofemoral nerve, lateral femoral cutaneous nerve, ilioinguinal and iliohypogastric nerves are all exposed in this area after retroperitoneal dissection during lumbar hernia repair [1, 2], which render the risk and challenge for lumbar hernia repair and mesh fixation. In addition, the superior and inferior lumbar hernias, although had the same name of lumbar hernia, are quite different according to the anatomical location and there is no standard and preferred method for lumbar hernia repair. However, strangulated primary lumbar hernia, although rare, may occur in about 9% of cases, especially in elderly patients [3, 4].

GRYNFELTT HERNIA INITIALLY DIAGNOSED AS LIPOMA: A CASE REPORT

Abstract: Lumbar hernia is a disease that presents unsual and difficult diagnosis. It is most prevalent in males and the elderly. It is presented the case of a 70-year-old male patient with previous trauma in the lumbar region 30 years ago and since then presented as a tumor in that region. He asked for a medical help and, initially, his case was diagnosed as a lipoma, but then Grynfeltt's hernia was identified and properly repaired. Keywords: Lumbar hernia; Grynfeltt hernia; superior lumbar hernia

Laparoscopic Repair of Lumbar Hernia: A Case Report and Mini Review

Lumbar hernias are quite rare, constituting 2% of all abdominal wall hernias, and they are usually secondary to trauma or previous surgery. Approximately 300 cases have been reported so far. There are two different types, depending on the location: superior lumbar or Grynfeltt’s hernia and inferior or Petit’s hernia. Abdominal computed tomography (CT) will provide accurate diagnosis. Laparoscopic repair with mesh is the treatment of choice, especially when the hernia is symptomatic. We describe the diagnosis and laparoscopic repair of a symptomatic right superior lumbar hernia in a female patient, with a review of the relevant literature. The patient provided her written consent for publication of the case and the photographs. A 48-year-old female was referred to the surgical clinic with a symptomatic right sided abdominal hernia. Clinical examination revealed an abdominal wall defect in the right superior lumbar region. Abdominal CT confirmed a right Grynfeltt’s hernia, containing ascending colon and fat, but with no signs of strangulation. She underwent laparoscopic lumbar hernia repair with mesh under general anaesthesia, with uneventful recovery. Lumbar hernia is a rare abdominal wall defect, which is usually secondary to trauma or previous surgery. A thorough history and clinical examination, along with abdominal CT, will provide accurate confirmation of the diagnosis. CT should always be included in the investigation prior to surgery, even in uncomplicated cases. The relevant literature is limited, but confirms that laparoscopic repair with mesh is the treatment of choice, especially when the hernia is symptomatic.

Laparoscopic total extraperitoneal superior and inferior lumbar hernias repair without traumatic fixation: Two case reports

BACKGROUND: The lumbar area is limited by the bone structures (superiorly by the 12th rib and inferiorly by the iliac crest); furthermore, several important nerves, including the genitofemoral nerve, lateral femoral cutaneous nerve, and ilioinguinal and iliohypogastric nerves, are all exposed in this area after retroperitoneal dissection during lumbar hernia repair, which render the risk and challenge for lumbar hernia repair and mesh fixation. In addition, the superior and inferior lumbar hernias, although had the same name of lumbar hernia, are quite different according to the anatomical location, and there is no standard and preferred method for lumbar hernia repair. In the present study, we present our techniques of total extraperitoneal (TEP) superior and inferior lumbar hernia repair. METHODS: The TEP approaches were performed in the superior and inferior lumbar hernias. Due to the different anatomic locations of the superior and inferior lumbar hernias, the trocar sites were also different. In the present procedure, with the use of self-gripping mesh, the traumatic fixation was avoided. RESULTS: After TEP lumbar hernia repair, both patients had minimal postoperative pain and were discharged 1 day and 3 days after operation without complications, respectively. CONCLUSION: Different pathways and trocar arrangement are necessary according to the different locations of superior and inferior lumbar hernias. The use of self-gripping mesh in the retroperitoneal space avoids the traumatic fixation, and TEP could be a promising technique for primary lumbar hernia repair.

Case Report of A Neonate with Congenital Superior Lumbar Hernia

Background: congenital lumbar hernias are rare. It constitutes to 20% of all lumbar hernias which is less than 1.5% of all the abdominal wall hernias. There are no more than 50 cases reported in literature till date. We report a case of congenital lumbar hernia in a preterm female neonate located on the superior lumbar triangle. Case: a preterm female neonate was born, presented with a mass at the right lumbar area with a size of 8x8 cm, round, movable with bluish discoloration, well delineated border, no visible veins, increases in size when the patient cries, and reduces easily. Ultrasonography revealed a right posterolateral abdominal mass measuring 4.2x2.88x1.59 cm. CT scan revealed right posterolateral mid-abdominal wall hernia with protrusion and no intestinal obstruction. The patient underwent exploratory laparotomy, where hernia defect was about 2 cm in diameter in the right posterior abdominal wall, pararenal area, and just below the 12th rib. The ascending colon and parts of the ileum were adherent inside the hernia defect at the right lumbar area. Primary closure of the hernia defect was done by suturing the psoas major and the transversus abdominis and internal oblique muscles. The postoperative, patient had good bowel movement, no abdominal distention or vomiting. Feeding was then started and well tolerated. After two weeks follow-up, there were no signs or symptoms of intestinal obstruction such as nausea and vomiting. Patient is being fed regularly and passes bowel movement almost 2-3 times a day. Conclusion: appropriate diagnosis of the extent of the defect through the advent of CT scan and early detection of other congenital anomalies should be routine in these cases. Open surgery with primary repair is almost always done but we can consider laparoscopic approach in the future with uncomplicated lumbar hernias.

Surgical approach towards Grynfelt hernia

Due to the rarity of Grynfelt hernia, there is no standardized surgical technique.From April 2010 to September 2017, 12 cases of primary superior lumbar hernia (Grynfelt hernia) were identified through medical records reviewing and included in our study. Perioperative data, surgical outcomes, and long-term follow-up results were retrospectively analysed.Male/female ratio of patients was 1:1, with age 69.5 (62, 74.5) [median (25 percentile, 75 percentile)] years old. Right/left side ratio of lumbar hernia was 9/3. The in-hospital duration was 7 (5, 8) days. The surgical duration was 35 (30, 50) minutes. The defect size was 2.1 (1.5, 3) cm in diameter. The discharge of the patient was on 3 (2, 4) post-operative day (POD). The meshes used were: MK5816 (10), MK5810 (1), and UHS (1). There was only 1 case of postoperative complication where the patient was admitted in intensive care unit (ICU) due to hypoxemia. Morbidity, mortality, and recurrence cases were null.Our study indicates that open surgery with mesh implantation is a reliable way for the management of primary superior lumbar hernia.

The Case with Superior Lumbar Hernia was Treated by Laparoscopic Radical Surgery Using VENTRALIGHT &lt;sup&gt;™&lt;/sup&gt; ST

The Case with Superior Lumbar Hernia was Treated by Laparoscopic Radical Surgery Using VENTRALIGHT &lt;sup&gt;™&lt;/sup&gt; ST

Bilateral superior lumbar hernias: a case report and review of literature

Primary lumbar hernias are uncommon. They present with backache, flank pain, occasional nausea, feeling of weight or dragging sensation in the lumbar region. When they are small, they may be unnoticed leading to significant morbidity with the patient seeking referrals and therapy with no resolution of symptoms. They should be repaired in time to avoid dreaded complications of obstruction and strangulation. A sixty-year man presented with swelling and pain in the left loin. On evaluation, he was found to have bilateral superior lumbar hernias, which was treated with mesh repair.

LAPAROSCOPIC REPAIR OF LUMBAR HERNIA (GRYNFELT): TECHNICAL DESCRIPTION

ABSTRACTBackground: Lumbar hernias are rare. Usually manifest with reducible volume increase in the post-lateral region of the abdomen and may occur in two specific anatomic defects: the triangles of Grynfelt (upper) and Petit (lower). Despite controversies with better repair, laparoscopic approach, following the same principle of the treatment of inguinal hernias, seems to present significant advantages compared to conventional/open surgeries. However, some technical and anatomical details of the region, non usual to general surgeons, are fundamental for proper repair. Aim: To present systematization of laparoscopic transabdominal technique for repair of lumbar hernias with emphasis on anatomical details. Method : Patient is placed in the lateral decubitus. Laparoscopic access to abdominal cavity is performed by open technique on the left flank, 1.5 cm incision, followed by introduction of 11 mm trocar for a 30º scope. Two other 5 mm trocars, in the left anterior axillary line, are inserted into the abdominal cavity. The peritoneum of the left paracolic gutter is incised from the 10th rib to the iliac crest. Peritoneum and retroperitoneal is dissected. Reduction of all hernia contents is performed to demonstrate the hernia and its size. A 10x10 cm polypropylene mesh is introduced into the retroperitoneal space and fixed with absorbable staples covering the defect with at least 3-4 cm overlap. Subsequently, is carried out the closure of the peritoneum of paracolic gutter. Results: This technique was used in one patient with painful increased volume in the left lower back and bulging on the left lumbar region. CT scan was performed and revealed left superior lumbar hernia. Operative time was 45 min and there were no complications and hospitalization time of 24 h. Conclusion: As in inguinal hernia repair, laparoscopic approach is safe and effective for the repair of lumbar hernias, especially if the anatomical details are adequately respected.

腹腔鏡下修復術を施行した腎臓摘出術後に発症した上腰ヘルニアの2例

腹腔鏡下修復術を施行した腎臓摘出術後に発症した上腰ヘルニアの2例