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Purpose of Review: Low back pain (LBP) is considered an important issue of public health, with annual prevalence estimations almost achieving 60% of the worldwide population. Available treatments have a limited impact on this condition, although they allow to alleviate pain and recover the patient's quality of life. This review aims to go deeper on the understanding of this condition, providing an updated, brief, and concise whole picture of this common musculoskeletal problem., Recent Findings: Scientific literature, current clinical practice and clinical guidelines are summarized, focusing on three key aspects: classification of LBP, diagnosis of symptomatic lumbar hernia, and intervention strategies (conservative, surgical, and pharmacological). Benefits and drawbacks of each approach are tackled. The most appropriate intervention for LBP suffers is hitherto a conservative treatment based on therapeutic exercise, manual therapy and therapeutic education on the neurophysiological mechanisms of pain. Whether patient's condition is severe, does not improve with conservative treatment, or presents neurological symptoms, then surgical intervention is recommended. The efficiency of pharmaceutical approaches for LBP lacks high-quality evidence-based studies, and still needs to be in-depth explored. Current treatments help to improve symptoms and patient's perspectives. However, further research in the field of herniated discs is essential in order to seek a therapy that could definitely cure or eliminate this condition., Competing Interests: Declarations. Patient Consent: Not applicable. Permission to Reproduce Material from other Sources: Figures are originals, they have not been acquired from other studies. Competing Interest: The authors declare no competing interests. Human and Animal Rights: This article does not contain any studies with human or animal subjects performed by any of the authors. Clinical Trial Registration: Not applicable., (© 2025. The Author(s).)

This case report discusses a unique case of renal eventration in a cat resulting from a lumbar hernia possibly of traumatic origin. A two-year-old indoor/outdoor male neutered domestic shorthair was evaluated for a rapidly growing mass noted in the right lumbar region. Initial physical examination revealed a firm, circular and slightly mobile mass in the lumbar region, along with pain and tenderness on palpation. Abdominal ultrasound revealed muscle discontinuity in the lumbar region consistent with a hernia, with eventration of the right kidney possibly caused by abdominal trauma. A paralumbar celiotomy was performed over the area of increased volume, revealing the right kidney with a hematoma on its surface and partial rupture of the renal capsule. The muscular defect was identified, and the kidney replaced in its anatomical location. The patient recovered quickly and was discharged from hospital 46 h later, with no reported complications. Recheck 2 months post-operatively confirmed unremarkable biochemical assessment (creatinine, urea and USG within normal limits) and abdominal ultrasound findings, and 2 years post procedure the patient remained clinically well. This unusual case emphasizes the importance of including renal eventration in the differential diagnosis for acutely presenting masses in the lumbar region of cats., Competing Interests: Declaration of competing interest All authors have reviewed and endorsed the manuscript, consenting to its submission to the journal ‘Topics in Companion Animal Medicine’. The authors declare the absence of any conflicts of interest. Each author has made contributions to the revision of the article and has approved the version being submitted., (Copyright © 2024. Published by Elsevier Inc.)

A congenital lumbar hernia is a rare type of hernia that can affect children born with lumbo-costo-vertebral syndrome. This case report is the first to describe a hybrid laparoscopic-assisted approach, which enabled precise intra-operative localization of a pediatric congenital lumbar hernia, and definitive surgical repair was then undertaken through an open approach. Unlike prior studies that have focused solely on either open or laparoscopic techniques, this hybrid approach offers a new strategy to improve surgical accuracy, particularly where imaging and clinical examination are inconclusive. Our literature review found that open and laparoscopic repair of congenital lumbar hernias are both safe and feasible approaches, with the choice of either depending on the surgeon's preference and expertise., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Townsville Hospital and Health Service Audit, Quality and Innovation Review (AQUIRE) issued approval THHSAudit 202403-574. This project meets the classification of non-research and has been approved for publication and presentation outside of Queensland Health by the Townsville Hospital and Health Service Audit, Quality and Innovation Review Panel. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Pornkul et al.)

Purpose: The aim of this work is to describe the rational, feasibility and clinical and Quality-of-life improvement results of a fully endoscopic preperitoneal repair for midline and lateral abdominal wall hernias, starting from the space of Retzius in a "bottom-to-up" approach., Methods: An observational prospective data-collected and quality of life study is performed in selected patients with less than 10 cm. in diameter midline and lateral abdominal wall hernias. A suprapubic upward e-TEP technique from a previously dissected Retzius space, is performed in all cases. The surgical goal is to perform a total free-tension abdominal wall reconstruction followed by a prosthetic hernioplasty. Clinical Data is classified in preoperative, intraoperative, and postoperative variables, including a quality-of-life clinical evaluation based on an improvement of HerQLes score., Results: A total of 30 patients underwent this approach from September 2017 to October 2022 in a single-surgeon practice. A total restoration of the previous abdominal wall anatomy and a prosthetic repair were achieved in all cases. The mean operative time was 142.53 min, with a significant shorter time in lateral hernias approach. Minor complications (Clavien-Dindo I) were collected in 10% of the patients. Major complications (Clavien-Dindo IIIb) occurred in 6.66% of the patients. The mean pain at discharge was 1.83 VAS, with a significant lower pain in M-eTEP approach for lateral hernias. The mean hospital stay was 42.4 h. No seroma, hematoma, chronic pain, or recurrence was observed in the mean follow-up (20.33 months). A clinical and quality of life improvement was found in 92.9% of the patients, measured by a minimal clinical important difference (MCID) between preoperative and postoperative HerQLes score., Conclusion: Despite being a technically demanding approach, the results obtained by this approach are compatible in safety and feasibility with other minimally invasive preperitoneal hernia repair techniques, in addition to obtaining a significant improvement in the quality of life of patients., (© 2024. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Traumatic abdominal wall hernia (TAWH) is a protrusion of contents through a defect in the abdominal wall as a consequence of a blunt injury. The objective of this review was to describe demographic and clinical aspects of this rare pathology, identifying the optimal moment for surgical intervention, evaluating the need to use mesh, and analyzing the effectiveness of surgical treatment. Thus, a systematic review using PubMed, Embase, and Scopus databases was carried out between January 2004 and March 2024. Computed tomography is the gold-standard imaging test for diagnosis. Open surgery is generally the preferred approach, particularly in emergencies. Acute TAWH can be treated by primary suture or mesh repair, depending on local conditions, while late cases usually require mesh., (Copyright © 2024. Published by Elsevier España, S.L.U.)

Background: Lumbar hernia is a rare disease with low incidence, and no golden standard surgical procedure has been established for lumbar hernias. The single-incision laparoscopic totally extraperitoneal sublay (SIL-TES) technique became a novel surgical technique for lumbar hernias. Methods: This retrospective study included 20 patients who underwent SIL-TES repair for lumbar hernia between April 2020 and March 2024. The baseline patient characteristics, intraoperative data, postoperative data, satisfaction score, and Carolina Comfort Scale scores were collected. Results: The results revealed that the SIL-TES technique for lumbar hernia repair is associated with a low complication rate, nonrecurrence, high satisfaction score, and high quality of life after surgery. Conclusions: The SIL-TES technique could be a feasible and effective surgical technique for lumbar hernias. A controlled study is needed for further confirmation.

Background: Flank and lumbar hernias (FLH) are challenging to repair. This study aimed to establish a reproducible management strategy and analyze elective flank and lumbar repair (FLHR) outcomes from a single institution., Methods: A prospective analysis using a hernia-specific database was performed examining patients undergoing open FLHR between 2004 and 2021. Variables included patient demographics and operative characteristics., Results: Of 142 patients, 106 presented with flank hernias, and 36 with lumbar hernias. Patients, primarily ASA Class 2 or 3, exhibited a mean age of 57.0 ​± ​13.4 years and BMI of 30.2 ​± ​5.7 ​kg/m 2 . Repairs predominantly utilized synthetic mesh in the preperitoneal space (95.1 ​%). After 29.9 ​± ​13.1 months follow-up, wound infections occurred in 8.3 ​%; hernia recurrence was 3.5 ​%. At 6 months postoperatively, 21.2 ​% of patients reported chronic pain with two-thirds of these individuals having preoperative pain., Conclusions: Open preperitoneal FLHR provides a durable repair with low complication and hernia recurrence rates over 2.5 years of follow-up., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: B. Todd Heniford reports a relationship with WL Gore that includes: funding grants and speaking and lecture fees. Vedra A. Augenstein reports a relationship with Allergan that includes: speaking and lecture fees. Vedra A. Augenstein reports a relationship with Pacira that includes: speaking and lecture fees. Vedra A. Augenstein reports a relationship with Bard that includes: speaking and lecture fees. Vedra A. Augenstein reports a relationship with Medtronic that includes: consulting or advisory. Vedra A. Augenstein reports a relationship with Vicarious Surgical that includes: consulting or advisory. Kent W. Kercher reports a relationship with WL Gore that includes: speaking and lecture fees. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Lumbar hernia is a rare disease, which can be acquired spontaneously or secondarily (post-traumatically, postoperatively…) or congenitally. It results from the existence of areas of weakness between the different muscles forming the posterior abdominal wall: the deep-seated Grynfeltt triangle and the superficial Jean-Louis Petit triangle., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Lumbo-costo-vertebral syndrome (LCVS) is a very rare congenital disorder seen in children. It is characterized by a congenital absence of ribs, vertebral anomalies, scoliosis, meningocele, and hypoplastic abdominal wall muscles presenting as abdominal wall hernia. We present a case of a six-year-old Indian female who came with complaints of swelling in the left lumbar region since birth, which was evident in coughing and scoliosis. On auscultation, bowel sounds were heard over the swelling. Physical examination revealed a left lumbar hernia and scoliosis. Abdominal X-rays revealed the absence of the 12th rib on the left side and vertebral anomalies with kyphoscoliosis. Abdominal ultrasonography (USG) showed a left lumbar hernia with bowel loops as its content. Computed tomography (CT) was done, which confirmed the X-ray and USG findings. Based on clinical and radiological findings, a diagnosis of LCVS associated with congenital lumbar hernia (CLH) was made. The patient was then referred to the surgery department for further management. This case illustrates a unique link between two extremely rare conditions and emphasizes the necessity of thorough clinical and radiological evaluation in suspected patients for early diagnosis and treatment., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Dhabalia et al.)

Purpose: Traumatic lumbar hernia (TLH) constitutes a protrusion of content through a defect in the posterior abdominal wall, as a result of injury. This rare entity has been described in limited number of cases., Methods: A systematic review of the literature was performed according to the meta-analysis of observational studies in epidemiology guidelines. The English literature from 1990 until 2021 was reviewed, using PubMed, EMBASE and Google Scholar bibliographic databases, to identify case reports and case series with patients that were diagnosed with TLH. For each eligible study, demographics, clinical presentation, hernia characteristics, preoperative imaging investigations, operation details, and postoperative data were extracted for assessment. Statistical analysis was performed on SPSS, version 20.0., Results: A total of 62 studies were included for review, with 164 patients with TLH. Mean age was (42.6 ± 14.3) years (47.6% males, 31.1% females, gender not specified in 35 cases). Mean diameter of hernia neck was (6.3 ± 3.1) cm, while the triangles of Petit and Grynfeltt were affected in 74.5% and 14.6%, respectively. Patients diagnosed in the emergency setting account for 54.2%, with CT scan establishing diagnosis in all but one case (97.7%). A delayed diagnosis was made in 45.8%, at a mean 1 year following trauma. Flank bulging (82.8%) and chronic back pain (34.3%) were the most frequent symptoms. In both delayed and acute group, open surgery (63.6% and 92.3%, respectively) was the preferred surgical approach. Postoperative complications were reported in 11.4% of acute and 15.0% of delayed patients. Hernia recurrence was 7%., Conclusions: TLH is uncommon with 164 cases described since 1990. CT scan is the gold standard in diagnosis. Open surgery is generally the preferred approach, particularly in the emergency setting. Acute TLH can be treated either by primary suture repair or mesh, depending on the local conditions, whereas delayed cases usually require a mesh., (Copyright © 2023 Chinese Medical Association. Production and hosting by Elsevier B.V. All rights reserved.)

A lumbar abdominal wall hernia is a protrusion of intraperitoneal or extraperitoneal contents through a weakness in the posterior abdominal wall, usually through the superior or inferior lumbar triangle. Due to its rare occurrence, adequate knowledge of anatomy and methods for optimal diagnosis and treatment might be lacking with many surgeons. We believe a clear understanding of anatomy, a narrative review of the literature and a pragmatic proposal for a step-by-step approach for treatment will be helpful for physicians and surgeons confronted with this condition. We describe the anatomy of this condition and discuss the scarce literature on this topic concerning optimal diagnosis and treatment. Thereafter, we propose a step-by-step approach for a surgical technique supported by intraoperative images to treat this condition safely and prevent potential pitfalls. We believe this approach offers a technically easy way to perform effective reinforcement of the lumbar abdominal wall, offering a low recurrence rate and preventing important complications. After meticulously reading this manuscript and carefully following the suggested approach, any surgeon that is reasonably proficient in minimally invasive abdominal wall surgery (though likely not in lumbar hernia surgery), should be able to treat this condition safely and effectively. This manuscript cannot replace adequate training by an expert surgeon. However, we believe this condition occurs so infrequently that there is likely to be a lack of real experts. This manuscript could help guide the surgeon in understanding anatomy and performing better and safer surgery., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Heemskerk, Leijtens and van Steensel.)

Background: Through a retrospective analysis of 16 cases of lumbar hernia, we discussed the anatomical basis, clinical manifestations, diagnosis, and treatment of this rare condition., Methods: We 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., Results: All patients underwent elective surgery performed by the same treatment team for superior lumbar hernias. The median area of the hernia defect was 12 cm 2 . 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., Conclusion: Lumbar hernias are rare and can be safely and effectively treated by open tension-free repair., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Introduction and Importance: Lumbar hernias are a rare type of hernia that occur in the posterior abdomen; they represent less than 3 % of all hernias, and approximately 350 cases have been reported in the medical literature. They can be categorized as congenital, traumatic, incisional, and spontaneous. Clinically they are not different from other hernias and the gold standard for diagnosis is computed tomography (CT) followed by tension-free plasty treatment., Case Presentation: We present the case of a 15-year-old female patient with a Petit's hernia, who was successfully treated using tension-free plasty., Clinical Discussion: Petit's hernia occurs more commonly between the ages of 50 and 70 years. Our case involved a 15-year-old female patient with a clinical presentation of an uncomplicated hernia that was managed by tension-free plasty., Conclusion: Petit's hernia is an uncommon hernia that requires a high index of suspicion the support of imaging studies to confirm diagnosis and provide treatment., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest regarding the preparation of this study., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Grynfeltt hernia (GH) is extremely rare among all abdominal wall hernias, so both diagnosis and treatment can be challenging. Surgery, open or laparoscopic, is the only definitive treatment. We present a case of a 71-year-old woman with GH (initially misdiagnosed as a lipoma), its approach, and treatment. We performed a hernioplasty with two meshes (preperitoneal and subaponeurotic position) by an open approach:  Sandwich  technique. This technique is safe, feasible, and associated with no short-term complications or relapses., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Cardoso et al.)

Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Superior lumbar hernias are extremely rare, and surgical repair is essential for their treatment. However, the direct observation of the hernial orifice is frequently difficult because the hernia disappears in prone or lateral positions, which is an issue when using the open approach. Therefore, using anatomical landmarks to detect the hernial orifice on preoperative CT scans may be useful for correct identification and visualization. Here, we report two cases of superior lumbar hernias successfully treated using the abovementioned method., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Akaishi et al.)

Purpose: Lateral abdominal hernias are inherently challenging surgical entities. As such, there has been an increase in the adoption of robotic platforms to approach these challenging hernias. Our study aims to assess and compare outcomes between open (oLAHR) and robotic (rLAHR) lateral abdominal hernia repair using a national hernia-specific database., Methods: A retrospective review of prospectively collected data from the Abdominal Core Health Quality Collaborative was performed to include all adult patients who underwent elective lateral hernia repair. A propensity score match analysis was conducted, and univariate analyses were conducted to compare these two surgical modalities across perioperative timeframes., Results: The database identified 2569 patients. Our analysis matched 665 patients to either the open or robotic groups. The median length of stay, surgical site occurrences (SSO), and surgical site occurrences requiring procedural interventions (SSOPI) were higher in the oLAHR versus the rLAHR group. Overall, oLAHR had a significantly higher rate of having any post-operative complications or any SSO/SSOPI. There was no difference in quality-of-life measures between groups at 30 days and 1 year., Conclusion: Robotic abdominal hernia repair is a safe alternative compared to the open repair of lateral abdominal hernias with better perioperative outcomes. Despite having a longer operative time, the robotic approach can offer a significantly shorter length of stay and an overall lower rate of complications. Ultimately, there is no difference in the quality-of-life measures both at 30 days and 1 year between the open and robotic approaches., (© 2022. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Lumbar hernias are quite rare, even more so when primary or of spontaneous nature. These defects in the lumbar region demand a comprehensive knowledge of the anatomy of the lateral abdominal wall and paraspinal muscles. Given the proximity of bone structures, they can pose a surgical challenge when trying to achieve an ideal dissection and appropriate mesh overlap. The authors report the case of a primary Petit's hernia that underwent an open anterior surgical approach with the use of a preperitoneal mesh. In addition to the described surgical technique, the article also aims to detail the diagnosis and anatomic classification of this rare pathology., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Alves et al.)

Retroperitoneal lumbar hernias are a rare entity. Atraumatic posterior perirenal hernias are an exceptionally rare form of retroperitoneal lumbar hernias. Because of their infrequency, there are no standardized methods of surgical care for the treatment of atraumatic (primary spontaneous) posterior perirenal hernias. This report documents the finding and management of an atraumatic posterior perirenal lumbar hernia in a 69-year-old female., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Slater et al.)

Purpose: Congenital lumbar hernia is defined as the protrusion of intraperitoneal or extraperitoneal viscera through a defect of the posterior abdominal wall, present at birth. The aim of our study was to perform a systematic review of this rare pathology, with emphasis on surgical decision-making., Methods: The English literature (2000-2020) was reviewed, using PubMed, EMBASE and GoogleScholar databases, combining the terms "hernia", "lumbar", "flank", "Grynfeltt", "Petit" and "congenital". Overall, 35 studies were included, describing 85 patients., Results: Mean age was 9.7 ± 20.7 months (range 1 day-10 years). 55.7% were males and 44.3% were females. All patients presented electively, with flank bulging as the main symptom. Superior lumbar triangle (Grynfeltt) herniae accounted for 41.8%, inferior lumbar triangle (Petit) herniae for 32.8%, whereas 25.4% were classified as diffuse. A left-sided hernia was observed in 47%, a right-sided in 42.4%, while 10.6% were bilateral. 71.8% of the patients had associated anatomical anomalies, mainly the lumbocostovertebral syndrome. Most patients (83.3%) were treated surgically, while 16.7% conservatively with surveillance. In 93.3%, the surgical approach was open, with laparoscopy employed in 6.7% of cases. The majority (71.7%) underwent primary suture repair of the hernia defect, whereas a mesh was required in 28.3%. Post-operative morbidity was 6.7% and recurrence rate was 3.3% at a mean follow-up of 26.4 months., Conclusion: Congenital lumbar hernia is a rare pathology in the paediatric population, with only 85 cases reported since 2000. Although the diagnosis is frequently straightforward, it should raise the suspicion for associated congenital anomalies and further investigation is required, with cross-sectional imaging. Surgical repair is usually performed during the first year, to allow for symmetrical torso development., (© 2021. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Competing Interests: Declaration of competing interest No conflicts of interest to declare.

Lumbar hernia is an uncommon condition that can either be congenital or acquired. Acquired lumbar hernia is further divided into primary, with no identifiable cause, and secondary, occurring due to previous trauma, infection, or surgery. Here, we present the case of inferior lumbar hernia in a 65-year-old Asian male who was a chronic alcoholic and smoker. He presented with a complaint of a longstanding swelling in the right lumbar region for five years and no other associated symptoms. The swelling was reducible, an expansile cough impulse was felt on palpation, and bowel sounds were heard on auscultation. A contrast-enhanced computed tomography scan revealed a 6.7 cm defect in the lateral abdominal wall in the right lumbar region with bowel loops, cecum, ascending colon, mesentery, and mesenteric artery seen herniating through the defect. There was a history of an iliopsoas abscess at the same site five years ago, which was treated with incision and drainage. The patient was advised for an open mesh repair but could not be operated upon due to coexisting aortic stenosis and regurgitation. Our impression, from this report, is that a chronic iliopsoas abscess tracking to the inferior lumbar region and the incision and drainage thereof, leading to a weakness in the abdominal wall, may be considered to be a cause of inferior lumbar hernia, with chronic smoking on part of the patient being a significant contributing factor for the abdominal muscle weakness. Therefore prompt and meticulous treatment of an iliopsoas abscess must be done to prevent this complication., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Kaur et al.)

Background: Lateral hernia (LH) repair is a challenging and debated topic in abdominal wall surgery because of the anatomical location and mesh placement and fixation. Large LHs should be managed with an open procedure; however, there is no consensus regarding the repair of small- to medium-sized LHs. We report our treatment of this type of LH using the transabdominal partial extraperitoneal (TAPE) technique. Methods: After retrospective review of the prospective hernia database at two hernia centers, patients with small- to medium-sized LHs who underwent the TAPE technique were identified and analyzed. The key components of our technique include wide dissection of peritoneum off the defect and use of that peritoneum to cover the lower and medial part of the mesh as much as possible. The parameters studied included patient demographics, intraoperative data, and postoperative outcome. Results: We studied 19 patients with small- to medium-sized LHs repaired using the TAPE procedure between 2017 and 2020. LH etiologies were primary hernia ( n  = 3), incisional hernia ( n  = 15), and traumatic hernia ( n  = 1). Mean defect size was 5.8 ± 2.1 cm (range 2.5-10 cm), mean operative time 118.1 ± 41.7 minutes (range 65-240 minutes), and mean postoperative stay 6.4 ± 2.0 days (range 6-9 days). There were no perioperative complications. At a mean follow-up of 20 months, no patient had recurrence of LH. Discussion: For small- to medium-sized LHs, the laparoscopic TAPE technique is minimally invasive and safe; the procedure is associated with minimal postoperative complications.

Background: Traumatic lumbar hernia is due to shearing of bony insertions of the muscle in the lumbar region. In recurrent cases, there is more attenuation of muscles. This makes fixation of the mesh extremely difficult. Hence, the need to develop a new technique., Case Report: A 27-year-old male presented with a recurrent post-traumatic right- sided lumbar hernia. He had a severe two wheeler accident. Following the accident he had undergone various surgical interventions for a fractured pelvis with a deglowing injury involving the right gluteal region and upper thigh. He had also developed a post-traumatic lumbar hernia for which he had undergone open mesh repair. Subsequently he developed recurrence of the post traumatic right-sided lumbar hernia. After complete investigation he underwent open mesh repair for the recurrent post traumatic lumbar hernia. The defect was wide and was devoid of healthy surrounding muscles. The mesh was fixed to the ileal bone with bone anchors and to the twelfth rib with trans-osseous fiber sutures passed through holes drilled in the twelfth rib. Flaps were created from the remnant surrounding attenuated muscles. They were double-breasted to cover the mesh. Postoperative outcome was excellent with no recurrence for the last six months., Discussion: The various anatomical and technical considerations of bone fixation of the mesh for hernia repair are discussed., Conclusion: Bone fixation of the mesh with bone anchors is a viable option especially in cases where there is severe attenuation of adjacent muscles for mesh fixation., Competing Interests: There are no conflicts of interest, (© 2022 Ketan Vagholkar.)

Lateral abdominal wall hernias are rare and inconsistently defined, which is why the use of the European Hernia Society classification makes sense, not least for the purpose of comparing the quality of surgical results. A distinction must be made between true fascial defects and denervation atrophy. Based on the available literature, there is generally a low level of evidence with no consensus on the best operative strategy. The proximity to bony structures and the complex anatomy of the three-layer abdominal wall make the technical treatment of lateral hernias difficult. The surgical variations include laparoendoscopic, robotic, minimally invasive, open or hybrid approaches with different mesh positions in relation to the layers of the abdominal wall. The extensive preperitoneal mesh reinforcement open, transabdominal peritoneal (TAPP) laparoscopic repair or total extraperitoneal (TEP) endoscopic repair has met with the greatest approval. The extent of the required medial mesh overlap is determined by the distance between the medial defect boundary and the lateral edge of the straight rectus abdominus muscles. The medially directed preperitoneal and retroperitoneal dissection can be extended into the homolateral retrorectus compartment by laterally incising the posterior rectus sheath or by crossing the midline behind the intact linea alba into the contralateral retrorectus compartment. The intraperitoneal onlay mesh (IPOM) technique is a suitable procedure only for smaller defects with possible defect closure but it is also important as an exit strategy in the case of a defective peritoneum. Individualized prehabilitative and preconditioning measures are just as important as the assessment of preoperative anamnestic and clinical findings and risks with radiographic cross-sectional imaging diagnostics., (© 2021. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Purpose: 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., Methods: 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., Results: 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 ± 2.8 cm 2 (range 4-12 cm 2 ), and the mean mesh area was 144.6 cm 2 (range 130-180 cm 2 ). The average operative time (skin to skin) was 49.0 ± 5.7 min (range 40-60 min), 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 1.5 days (range 1-2 days). No serious postoperative complications occurred. No recurrence, chronic pain, or mesh infection occurred during a mean follow-up period of 7.5 months., Conclusions: 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., (© 2020. Springer-Verlag France SAS, part of Springer Nature.)

Background/aim: Lumbar 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., Methods: Patients 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., Results: A 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., Conclusions: Lumbar hernia is a relatively rare entity, and inferior lumbar hernia is rarer. It is feasible to repair lumbar hernia under local anesthesia., (© 2021. The Author(s).)

Grynfeltt-Lesshaft hernia is a type of lumbar hernia located in the superior lumbar triangle. Lumbar hernias are rare hernias. Clinical diagnosis of lumbar hernias can be a challenging especially in obese or asymptomatic patients. Lumbar hernias have been frequently misdiagnosed and lead to serious complications. Surgery (open or laparoscopic) is recommended to correct the defect and to avoid the exacerbation of the hernia and associated complications. The majority of the reported cases in the past were diagnosed on a CT scan. This study presents a case of successful detection of a Grynfeltt-Lesshaft hernia by US scan then confirmed by a subsequent CT scan. The aim of this case report was to Increase knowledge of lumbar hernias and to demonstrate the role of US in the diagnosis of lumbar hernias., Competing Interests: None declared., (© 2021 Australasian Society for Ultrasound in Medicine.)

Background: The social impact and economic burden of low back pain are well known among the medical community. A novel therapeutic approach is represented by oxygen-ozone therapy, whose anti-inflammatory effects could be especially useful in patients with herniated discs. The most common administration is through a palpation-guided injection technique, although the use of ultrasound guidance could allow a more precise delivery of the therapeutic substance close to the nerve root., Aim of the Study: To describe the clinical outcomes following US-guided periradicular injection of oxygen-ozone as a treatment option for low back pain associated to sciatica in patients affected by symptomatic L5-S1 disc herniation., Conclusion: Ultrasound-guided periradicular injection of oxygen-ozone in L5-S1 herniation is a safe and effective minimally invasive treatment, able to improve both low back and radiating pain.

Congenital lumbar hernias are uncommonly seen in the pediatric age group, with only about 60 cases reported in the literature. It is usually accompanied by a multitude of congenital anomalies involving different organ systems of the body. For instance, it may involve the ribs, spine, muscles, and the kidneys. Herein, we report a case of congenital lumbar hernia in an 8-month-old boy who underwent an operative repair using a mesh with an uneventful outcome., Competing Interests: The authors declare no financial disclosures or conflicts of interest., (Copyright © 2021 by S. Karger AG, Basel.)

Iliac vein injury in the absence of pelvic fractures is rare. We present the case of a 27-year-old male involved in a motorcycle crash. Imaging demonstrated a lumbar hernia and pelvic hematoma in the absence of pelvic fractures. The patient became unstable and required emergency surgery demonstrating an iliac vein injury requiring ligation. Diagnosis and management of this rare injury is reviewed., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Sheets et al.)

Purpose: The aim of this paper is to propose our four-step technique, an open extraperitoneal approach for complex flank, lumbar, and iliac hernias., Methods: A big polypropylene mesh is placed, covering and reinforcing all the lateral abdominal wall in an extraperitoneal space. Its borders are retroxiphoid fatty triangle and the costal arch cranially and the retropubic space caudally, psoas muscle, and paravertebral region posteriorly and contralateral rectus muscle medially. Mesh dimensions do not depend from the defect size, but prosthesis has to cover all the lateral abdominal wall., Results: No major complications have been reported. The mean length of stay is 4.8 days (range 3-11). Mean follow-up is 44.8 months (range 5-92). One recurrence (4.5%) has been reported at the 1-year clinical evaluation., Conclusion: In conclusion, we believe that regardless size and location of the defect, every complex lateral hernia requires the same extensive repair because of the critical anatomy of the region with a big medium-heavyweight polypropylene mesh placed in an extraperitoneal plane, the only one that allows adequate covering of the visceral sac. Our technique is a safe, feasible, and reproducible treatment for this challenging surgical problem.

Background: The optimal surgical treatment for lateral hernias of the abdominal wall remains unclear. The presented prospective study assesses for the first time in detail the clinical value of a totally endoscopic sublay (TES) technique for the repair of these hernias., Methods: Twenty-four consecutive patients with a lateral abdominal wall hernia underwent TES repair. This technique is naturally combined with a transversus abdominis release maneuver to create a sufficient retromuscular/preperitoneal space that can accommodate, if necessary, a giant prosthetic mesh., Results: The operations were successful in all but one patient who required open conversion because of dense intestinal adhesion. The mean defect width was 6.7 ± 3.9 cm. The mean defect area was 78.0 ± 102.4 cm 2 (range 4-500 cm 2 ). The mean mesh size used was 330.2 ± 165.4 cm 2 (range 108-900 cm 2 ). The mean operative time was 170.2 ± 73.8 min (range, 60-360 min). The mean visual analog scale score for pain at rest on the first day was 2.5 (range 1-4). The average postoperative stay was 3.4 days (range 2-7 days). No serious complications (Dindo-Clavien Grade 2-4) were seen within a mean follow-up period of 13.3 months., Conclusions: A totally endoscopic technique (TES) for the treatment of lateral hernias is described. The technique revealed to be reliable, safe and cost-effective. The first results are promising, but larger studies with longer follow-up periods are recommended to determine the real clinical value.

The presence of a new lumbar swelling or pain in the postoperative period following laparoscopic surgery should raise the suspicion of a lumbar hernia. Cross-sectional imaging can be used to establish an early diagnosis to enable successful management., Competing Interests: All authors have disclosed no conflict of interest., (© 2021 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.)

Previous reports have described laparoscopic mesh repair for lumbar hernia due to iliac crest bone harvest, but there have been no reports of reoperation with laparoscopic mesh repair for recurrent cases after laparoscopic mesh repair. Here, we describe the case of a 72-year-old Japanese woman with lumbar hernia recurrence 6 years after laparoscopic mesh repair for lumbar hernia due to iliac crest bone harvest. We performed a successful reoperation with laparoscopic mesh repair. Laparoscopic surgery should be considered to elucidate the mechanism of recurrence, previous mesh position, and the area that must be covered to prevent recurrence again., (© 2020 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and John Wiley & Sons Australia, Ltd.)

Petits hernia is a rare defect in the abdominal wall located in the lower lumbar triangle. The herniation in the Petiti trigonum is complicated by bowel incarceration in about 9% of cases, most often of the large bowel. We present a case report of a 73-year-old patient with clinical manifestations of large bowel obstrution. The patient was admitted and indicated for urgent surgery. Incarcerated left lumbar hernia in the Petits triangle with herniation of sigmoid colon that showed no signs of ischemia was found. Reposition of the sigmoid colon and hernioplasty of the lumbar hernia was performed. There were no postoperative complications and the patient was discharged on postoperative day 9. The presented case report shows that the lumbar hernia (Petit) may result in bowel obstruction and thus may cause a life-threatening condition that requires urgent surgical intervention.

Background: A 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., Methods: Twelve 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., Results: All 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 cm 2 . 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., Conclusion: Sublay repair for primary superior lumbar hernia with the Kugel patch shows benefits including a reliable repair, minimal invasiveness and few post-operative complications., (© 2020 The Authors ANZ Journal of Surgery published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Surgeons.)

Hernias of the lateral abdominal wall are a rare entity. In most cases, they occur after surgery or trauma. We present two cases of lumbar hernia: the first one after iliac bone grafting and the second one after muscular tearing by the seatbelt during a car accident. Both cases were successfully repaired using a propylene mesh with bone fixation., (Copyright: © 2020 Permanyer.)

Introduction: Ehlers-Danlos syndrome (EDS) is a rare and diverse group of heritable connective tissue disorders. Gastrointestinal manifestations and abdominal pain are frequent in most subtypes of EDS. Conservative treatment is the standard of care., Presentation of the Case: A 43-year-old female patient with genetically confirmed EDS classic subtype presented with diffuse gastrointestinal symptoms (bloating, belching and pain) that were controlled by the patient through inclined posture and external abdominal compression. A standard abdominoplasty with rectus muscle plication and mesh implantation lead immediately to complete relief of symptoms, which allowed the patient to assume an upright posture and resume all daily activities again. After 7 years, the patient was again seen with severe, persistent abdominal pain and inclined posture related to right lumbar herniations, as confirmed by MRI. However, there was no recurrence of the previous abdominal midline weakness and related gastrointestinal symptoms. Following lumbar hernia repair and mesh implantation, the patient was free of abdominal pain and resumed an upright posture again., Discussion: Although conservative treatment of EDS is primarily recommended and most surgeons are reluctant to operate on these patients except in life threatening situations, we present the successful surgical relief of disabling abdominal symptoms., Conclusion: Regarding the variability and complexity of symptoms in different subtypes of EDS, a personalized multimodal treatment including surgical approaches should be considered and achieved a significant and long-lasting improvement in quality of life in our patient., (Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Introduction: Lumbar hernia is a rare hernia in the posterolateral abdominal wall and only about 310 cases are known to have been reported to date. Laparoscopic hernioplasty is a common surgical approach but is unsuitable for patients who have previously undergone laparotomy and are expected to have extensive visceral adhesions., Presentation of Case: An 84-year-old woman who had undergone an open distal gastrectomy was referred to our hospital with an enlarging but easily reducible bulge in the right upper back. On computed tomography, the hernial orifice was located in the lateral side of the right quadratus lumborum under the costal arch. The bulge was diagnosed as a superior lumbar hernia. We performed an open hernioplasty in the prone position to avoid internal visceral adhesions. The hernia sac was detected in the latissimus dorsi in the back, and was found to contain the ileocecum, which was rigidly adherent to the sac. Hernioplasty was performed by inserting polypropylene mesh between Zuckerkandl's fascia and the internal oblique., Discussion: Mechanical ileus after open distal gastrectomy is common complication and sometimes position was simple procedure without the influence of visceral adhesion and easily reinforced by underlay mesh., Conclusions: Open hernioplasty in the prone position using a mesh underlay is an optional approach in a patient with a superior lumbar hernia after gastrectomy., (Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Lumboiliac or lumbar hernia is a rare defect in the posterolateral abdominal wall that may be inadvertently misidentified and interfere with the implantable pulse generator (IPG) portion of spinal cord stimulator (SCS) implants. We report the case of a 54-year-old Caucasian man with an incidental finding of a lumboiliac hernia in the inferior lumbar triangle of Petit with placement of an IPG in a SCS implant. With the assistance of surgical colleagues, the correct diagnosis was made intraoperatively. We describe the operative repair of the lumboiliac hernia with a synthetic mesh. A new IPG pocket was created above the mesh prior to proceeding with IPG placement. No recurrence of the hernia defect was observed on 2-month follow-up. It is important that pain physicians and neurosurgeons who perform SCS implants are aware of lumboiliac hernias to avoid potential diagnostic or management errors. Lumboiliac hernias should be included on the differential diagnosis of lumbar or flank masses. Confirmation with imaging may be necessary and definitive surgical treatment should be pursued., Competing Interests: Competing interests: None declared., (© American Society of Regional Anesthesia & Pain Medicine 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Lumbar hernias are from weakened areas in the posterior lateral abdominal wall. Minimally invasive techniques are recommended for nonmidline abdominal wall hernias. Endoscopic methods utilizing the subcutaneous space only are rarely reported. A 66-year-old man presented with abdominal pain and a computed tomography (CT) scan revealing a lumbar hernia. The procedure was done utilizing the subcutaneous space to open the hernia sac and repair the defect in layers. A sublay mesh and an onlay mesh were used within the subcutaneous pocket. The patient had an uneventful postoperative course and was discharged home. A subsequent CT scan showed that the completed repair remained intact. Few endoscopic lumbar hernia repairs are reported despite the advantageous aspects of the procedure in avoiding the peritoneal cavity and the retroperitoneum., (© 2019 Baylor University Medical Center.)

Background: Lumbo-costo-vertebral syndrome is a set of rare abnormalities involving vertebral bodies, ribs, and abdominal wall., Case: We present a case of Lumbo-costo-vertebral syndrome in a 6-month old female infant who had a progressive swelling over the right lumbar area since birth. Clinical examination revealed a reducible swelling on the right flank with positive cough impulse. Ultrasonography showed a defect containing bowel loops in the right lumbar region. Chest X-ray revealed scoliosis and hemivertebrae with absent lower ribs on the right side. Computer tomography scan showed hernia sac containing the bowel and the right lobe of the liver with cross fused kidney., Conclusion: Lumbo-costo-vertebraly syndrome is a rare condtion which could be associated with different organ malformations. Simple closure or meshplasty could be done depending on the size of the defect.

Primary lumbar hernia is a rarely encountered hernia. Surgical correction is the standard treatment for lumbar hernia, and either an open or laparoscopic procedure can be performed with equivalent success. However, open repairs are most commonly performed. Here, we present a case of a primary lumbar hernia that was successfully treated laparoscopically and discuss surgical modalities of treatment reported in the literature. There are two laparoscopic approaches: transabdominal and extraperitoneal. The main advantage of the laparoscopic approach is that it helps the surgeon to precisely locate and evaluate the characteristics of the defect. It also has a lower morbidity rate, shorter length of hospital stay, less postoperative pain, and an earlier return to daily routine activities than the open approach. In the present study, a patient with a superior lumbar hernia was treated laparoscopically by the transabdominal approach. Laparoscopic repair in such cases is feasible and achieves a good result when done by an experienced laparoscopic hernia surgeon., (© 2018 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and John Wiley & Sons Australia, Ltd.)

Lumbar hernias can be superior (Grynfelt) and inferior (Petit). Inferior lumbar hernias are extremely rare and, therefore, are associated with diagnostic difficulty. We present a case of a primary spontaneous inferior lumbar hernia in a 79-year-old woman that was initially diagnosed as a large lipoma on ultrasound. The first operation was abandoned and an open mesh repair was conducted. Lumbar hernias can be primary acquired (55%), secondary acquired (25%) or congenital (20%). Cross-sectional imaging by CT or MRI appears to be the gold standard in diagnosis as ultrasound may lead to misdiagnosis. Strangulation, incarceration and obstruction are recognised complications, requiring prompt surgical intervention. There are currently no guidelines for surgical managements, although laparoscopic surgery may give the best results. In view of the scarcity of published cases, we aim to add to the literature to raise the index of suspicion and to promote prompt surgical management of lumbar hernias.

Background: Superior lumbar hernia is a rare posterolateral abdominal wall defect and herniation of abdominal contents through the superior lumbar triangle. A lumbar hernia is an unusual defect and only 300 cases of primary lumbar hernias have been reported since the first case report in 1731. To date, most clinicians are usually unfamiliar with the presentation of lumbar hernias, and the diagnosis is often done in a wrong way., Case Report: A 55-year-old female patient presented with complaints of right flank pain and swelling on the right lumbar region. On abdominal examination, there was round protruding swelling immediately beneath the 12 th rib of the right upper flank area. The swelling was palpable and bowel sound was heard over it. The swelling was easily reducible and protruded when the patient was coughing or straining. The opposite side of the lumbar region was normal, and chest examination was clear and normal. The hematological and urine analysis laboratory findings were normal., Discussion: The ultrasound finding revealed the bowel contents within the hernial sac. With the diagnosis of primary acquired superior lumbar hernia, the patient underwent open surgery. The defect was reduced back and repaired using a retro-muscular or sublay prolene mesh (15 cm by 7.5 cm). The patient was discharged at post-operative day four and followed-up for four months., Conclusion: In conclusion, the diagnosis of lumbar hernias should be considered in all patients presented with complaints of flank pain and swelling in the flank area. In the absence of obvious swelling in the flank region, ultrasound investigation might not establish the diagnosis of lumbar hernias. Hence, ultrasound would be the option to confirm the diagnosis when the swelling is palpable., Competing Interests: Disclosure The authors report no conflicts of interest in this work.