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Laterale Bauchwandhernien sind selten und werden uneinheitlich definiert, weswegen die Anwendung der Klassifikation der Europaischen Herniengesellschaft (EHS) nicht zuletzt zur Vergleichbarkeit der chirurgischen Ergebnisqualitat sinnvoll ist. Zwischen echten faszialen Defekten und Denervationsatrophien muss unterschieden werden. Es besteht basierend auf der verfugbaren Literatur ein niedriger Evidenzlevel ohne Konsens zur besten operativen Strategie. Die Nahe zu knochernen Strukturen und die komplexe Anatomie der dreischichtigen Bauchwand machen laterale Hernien versorgungstechnisch schwierig. Die chirurgischen Varietaten umfassen laparoendoskopische, robotische, minimal-invasive, offene oder Hybridzugange mit unterschiedlichen Netzpositionen in Bezug auf die Bauchwandschichten. Die grosflachige praperitoneale Netzverstarkung offen, transperitoneal laparoskopisch (TAPP) oder total endoskopisch praperitoneal (TEP) erfahrt die breiteste Zustimmung. Das notige Ausmas der medialen Netzuberlappung wird determiniert von der Distanz der medialen Defektbegrenzung zum lateralen Rand der geraden Bauchmuskulatur. Die medialwarts gerichtete pra- und retroperitoneale Dissektion kann durch laterale Inzision der hinteren Rektusscheiden in die homolaterale bzw. durch Uberkreuzung der Mittellinie hinter der intakten Linea alba bis in das kontralateral des Herniendefektes gelegene retrorektale Kompartment (RRK) ausgedehnt werden. Die intraperitoneale Onlay-mesh-Technik (IPOM) ist nur fur kleinere Defekte mit moglichem Defektverschluss ein geeignetes Verfahren, bleibt aber auch als „Exit-Strategie“ bei defektem Peritoneum wichtig. Individualisierte prahabilitative und prakonditionierende Masnahmen sind ebenso wie die praoperative anamnestische und klinische Befund- und Risikoeinschatzung mit radiographischer Schnittbilddiagnostik mandatorisch.

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.

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.

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 ± 2.8 cm2 (range 4–12 cm2), and the mean mesh area was 144.6 cm2 (range 130–180 cm2). 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. 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.

Highlights • Ehlers-Danlos syndrome is a rare and diverse group of connective tissue disorders. • Gastrointestinal manifestations are frequent in Ehlers-Danlos syndrome. • Few publications have reported on surgical managment of Ehlers-Danlos syndrome. • Multiple surgical interventions may be necessary if conservative treatment fails., 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.

Lumbar hernias are rare abdominal wall defects. Fewer than 400 cases have been reported in the literature and account for 2% of all abdominal wall hernias. Lumbar hernias are divided into Grynfelt-Lesshaft or Petit hernias. The former are hernia defects through the superior lumbar triangle, while the latter are defects of the inferior lumbar triangle. Primary lumbar hernias are further subdivided into congenital or acquired hernias and can further be classified as either primary or secondary. Secondary hernias occur after previous flank surgeries, iatrogenic muscular disruption, infection, or trauma. We review a rare presentation of metachronous symptomatic bilateral secondary acquired lumbar hernia following spine surgery. A successful laparoscopic transabdominal lumbar hernia repair with extraperitoneal mesh placement was performed, with resolution of the hernia symptoms. An extensive literature review regarding lumbar hernia and different types of repairs was performed.

Highlights • Lumbar hernia is a rare hernia occurring in the posterolateral abdominal wall and • suitable for laparoscopic hernioplasty. • Intraabdominal approach is sometimes difficult for superior lumber hernia after gastrectomy with expected visceral adhesions. • Open hernioplasty with underlay mesh in prone position is an optional approach to avoid internal visceral adhesion. • Mesh must be set between Zuckerkandl’s fascia and internal oblique to avoid prolapse of abdominal and retroperitoneal organs., 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.

Aim “Incisional hernias are very common and can present even after minimally invasive surgery for other pathologies. Laparoscopic ventral hernia repair first described by LeBlanc in 1992, gained great popularity, because of its known advantages over the open techniques. In the last decade because of increasing concerns about the future risks of using an intra-peritoneal mesh, several minimally invasive techniques using a mesh outside abdominal cavity have been described. We report the use of a TAPP technique.” Material and Methods “48 yo female patient, that underwent a laparoscopic right adrenalectomy, for myelolipoma, in 2015, with subsequent incisional lumbar hernia (L4W1) in the extraction incision.” Results “The patient was submitted to a laparoscopic TAPP repair in ambulatory surgery with extended recovery. The hernia defect was closed with a barbed suture and it was used a 15x15cm medium weight polypropylene mesh without traumatic fixation. For pain control it was done a TAP block guided by laparoscopy. The duration of surgery was 90 minutes. The patient had no complications. No recurrence on follow-up (4 months).” Conclusions “New minimally invasive procedures for the repair of incisional hernias avoid the intraperitoneal mesh position and maintain all the advantages of the minimally invasive approach. Some of these techniques may be complex and have a long learning curve. TAPP seems reproducible and a good option if a good extra-peritoneal dissection is possible. Larger series are needed, to accurately compare these new techniques with IPOM, open sublay and to select the best technique for each patient.”

Aim Posterior component separation with transversus abdominis release (PCS-TAR) represents a good option for challenging complex ventral hernia repairs. We present a case of PCS-TAR for a giant lumbar hernia in a patient with a transplanted kidney. Material and Methods The patient is a 46 years old man with a Charlson Comorbidity Index of 2 and a BMI of 27.5 kg/m2 who underwent a kidney transplant in 2005 and a subsequent open repair with mesh implantation for an incisional hernia in 2007. Two years later, he experienced a hernia recurrence, but chose conservative management. In 2019, the patient complained of progressively worsening pain and bulky sensation. Due to the size and location of the defect and the massive relaxation of the muscle fibers, open repair with PCS-TAR was indicated. Results In 2019, the patient underwent right-sided PCS-TAR with retromuscular placement of one polyvinylidene fluoride (PVDF) mesh and one biosynthetic mesh. Duration of the procedure was 295 minutes. Two drains were placed, respectively in the subfascial and in the subcutaneous plane. Postoperative course required non-invasive ventilation for respiratory distress, but was otherwise uneventful and he was discharged on postoperative day 8. After 12 months, the patient showed no signs of recurrence. Conclusions PCS-TAR is a versatile technique for the repair of complex ventral hernias, with an acceptable rate of postoperative complications and good long-term outcomes.

Bilateral lumbar hernias are rare. There is a paucity of literature regarding the anaesthesia techniques used and challenges faced. In the present era of minimally invasive surgery, laparoscopy has gained name and fame and is the modality of choice for hernia repairs. Methods: We report a series of 4 cases of bilateral lumbar hernia operated in our institute, using 4 different anaesthesia techniques over a period of 2 years and 9 months with the aim to focus on the varied anaesthetic techniques and the advantages and disadvantages of each. Results: General anaesthesia supplemented with epidural anaesthesia is recommended for laparoscopic repair, while in very high risk cases, combined segmental spinal- epidural anaesthesia may be a better option. Low dose segmental spinal provides commendable cardiovascular stability. It is a useful alternative in patients with multiple comorbidities, cardiac and respiratory diseases and aids early recovery and ambulation. Conclusion: Irrespective of the type of anaesthesia technique administered, patients’ safety and comfort should be of prime importance, while maintaining optimum haemodynamics and physiology.

Lumbar hernias of the lateroposterior abdominal wall have a low prevalence, being described in the scientific literature as sporadic cases or short series. Initially, they manifest as a painless tumor that can be confused with other more frequent pathologies such as soft-tissue tumors, lipomas, hematomas, or abscesses. We present the case of a 72-year-old female patient who, after removal of a lumbar lipoma by dermatology, was referred to our clinic for recurrence of tumor. An ultrasound scan showed a recurrence of the lipoma. The anamnesis and physical examination suggested lumbar hernia. Computerized axial tomography scan confirmed the clinical diagnosis, and surgery was indicated.

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 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. 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., Repair for superior lumbar hernias is technically challenging. Sublay repair using the Kugel mesh is a feasible and effective method for superior lumbar hernias. Sublay repair for superior lumbar hernias provides the advantages of reliable repair and rapid recovery.

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.

Background Rare locations of hernias, as well as primary ventral hernias under certain circumstances (cirrhosis, dialysis, rectus diastasis, subsequent pregnancy), might be technically challenging. The aim was to identify situations where the treatment strategy might deviate from routine management. Methods The guideline group consisted of surgeons from the European and Americas Hernia Societies. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used in formulating the recommendations. The Scottish Intercollegiate Guidelines Network (SIGN) critical appraisal checklists were used to evaluate the quality of full‐text papers. A systematic literature search was performed on 1 May 2018 and updated 1 February 2019. The Appraisal of Guidelines for Research and Evaluation (AGREE) instrument was followed. Results Literature was limited in quantity and quality. A majority of the recommendations were graded as weak, based on low quality of evidence. In patients with cirrhosis or on dialysis, a preperitoneal mesh repair is suggested. Subsequent pregnancy is a risk factor for recurrence. Repair should be postponed until after the last pregnancy. For patients with a concomitant rectus diastasis or those with a Spigelian or lumbar hernia, no recommendation could be made for treatment strategy owing to lack of evidence. Conclusion This is the first European and American guideline on the treatment of umbilical and epigastric hernias in patients with special conditions, including Spigelian and lumbar hernias. All recommendations were weak owing to a lack of evidence. Further studies are needed on patients with rectus diastasis, Spigelian and lumbar hernias., This guideline addresses the treatment of umbilical and epigastric hernias in clinically challenging situations (cirrhosis, dialysis, subsequent pregnancy, rectus diastasis), as well as the treatment of Spigelian and primary lumbar hernias. Emphasises the need for better evidence

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.

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

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 Conclusions Lumbar hernia is a relatively rare entity, and inferior lumbar hernia is rarer. It is feasible to repair lumbar hernia under local anesthesia.

Aim: Lumbar hernias are rare; Petit’s lumbar hernia (PLH), which is among them, is a rarer hernia type. Surgical repair is a standard treatment after the diagnosis of lumbar hernia. Controversy continues regarding the surgical technique of repairing Petit’s lumbar hernia. With this study, we aim to share short term results we obtained from the application of bilayer repair technique with mesh (BRTM), which is a new method in petit lumbar hernia treatment. Material and Method: Five patients who were diagnosed with lumbar hernia and treated between 2017 and 2020 were examined retrospectively. Results: Most patients consisted of women (n=4). The mean age was 58.2 years. As for the etiological reason of the disease, 3 patients were trauma-related and 2 patients were previous operations-related. The petit lumbar hernia defect diameter was 6.42. In all patients, BRTM was used. The mean length of hospitalization was 3.6 days. The mean follow-up duration was 13.8 months. There was no recurrence in any of the patients after follow-up. Conclusion: PLH requires a difficult management from diagnosis to treatment. Thanks to such a strong BRTM, not merely tissue integrity can be ensured, but also anatomical structures will become more organized, and intra-abdominal pressure will be evenly distributed to the preperitoneal area, creating a suspensory mechanism, also, since recurrence will be minimized, we predict that the surgery operation can be performed safely through BRTM in petit lumbar hernia. To support this technique, long-term follow-up and multi-centered studies are necessary.

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.

Congenital lumbar hernia is a rare disease affecting mainly infants. Its association with lumbo-costo-vertebral syndrome (LCVS) is hardly seen in the literature. We present a case of LCVS in a 1-month-old female infant presenting with a soft bulge in left lumbar region. Abdominal X-ray revealed absence of multiple ribs with a mild lumbar scoliosis and defective ninth vertebra. Ultrasonography showed absence lateral abdominal wall muscles in left lumbar region and 2.5 cm diameter lumbar hernia. Primary repair of the adnominal wall defect was performed without meshplasty and no recurrence was reported. We hope to enhance the literature of this rare disease with our case.

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.

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.Las eventraciones de la pared lateral del abdomen son poco frecuentes. Pueden ser posquirúrgicas o causadas por agentes traumáticos. Se presentan dos casos de eventración lumbar: el primero tras una resección ósea por autoinjerto de cresta ilíaca y el segundo por desinserción muscular por cinturón de seguridad secundaria a un accidente en la vía pública. Ambos fueron resueltos quirúrgicamente con colocación de una malla de polipropileno fijada a hueso.

Petit’s 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 Petit’s 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.

Autologous breast reconstruction with a perforator flap has become increasingly popular. The free lumbar artery perforator (LAP) flap has been described as a good alternative for autologous breast reconstruction. The LAP flap is a perforator flap based on a single pedicle. This flap is easy to harvest, with minimal donor-site morbidity. We present a case of a lumbar incisional hernia after LAP flap breast reconstruction in a 53-year-old patient. The patient had been treated with a bilateral mastectomy for cancer. Secondary breast reconstruction was performed with a bilateral DIEP flap. Reoperation was necessary because of a failed DIEP flap at the left side. Reconstruction was performed with a free LAP flap. The patient was referred for a right lumbar incisional hernia at the donor-site of the LAP flap. Open repair was performed with a retroperitoneal mesh. The thoracolumbar fascia was closed in with a running suture. Lumbar artery perforator is a perforator flap based on a single pedicle. Although it does not sacrifice any muscle and seems to be associated with minimal donor-site morbidity, we present the first report of a lumbar incisional hernia repair after LAP flap breast reconstruction treated using an open retroperitoneal mesh repair.

Introduction: Lumbar hernia defects were first described by Barbette in 1672 and later published by Degarangeot in 1731.1 The Petit triangle was believed to be the origin of all posterior abdominal...

Introduction: The author presents a case report of a rare lumbar hernia. Case report: A 69 years old woman came to our outpatient room with a big mass in the right lumbar area. The CT scan revealed a big lumbar hernia containing the right kidney, the colon and small intestine. The patient underwent an uneventful open hernioplasty with the use of a prolene mesh. Conclusion: Lumbar hernia occurs very rarely. Open hernioplasty with the use of a mesh is the method of choice in big hernias. Small hernias can be repaired laparoscopically.

We report a unique case of unilateral renal agenesis, spinal dysraphism, lumbar hernia, congenital talipes equino varus, and natal teeth associated with sacrococcygeal teratoma (SCT). The occurrence of this rare association in a neonate has not been reported in the literature. The theory of defective mesenchymal precursor cells from primitive node may explain the presence of associated malformations (related to defective mesenchyme) and presence of SCT.

Purpose The lumbar abdominal wall hernia is a rare hernia in which abdominal contents protrude through a defect in the dorsal abdominal wall, which can be of iatrogenic, congenital, or traumatic origin. Two anatomical locations are known: the superior and the inferior lumbar triangle. The aim of this systematic review is to provide a clear overview of the existing literature and make practical clinical recommendations for proper diagnosis and treatment of the primary lumbar hernia. Methods The systematic review was conducted according to the PRISMA guidelines. A systematic search in PubMed, MEDLINE, and EMBASE was performed, and all studies reporting on primary lumbar hernias were included. No exclusion based on study design was performed. Data regarding incarceration, recurrence, complications, and surgical management were extracted. Results Out of 670 eligible articles, 14 were included and additional single case reports were analysed separately. The average quality of the included articles was 4.7 on the MINORS index (0–16). Risk factors are related to increased intra-abdominal pressure. CT scanning should be performed during pre-operative workup. Available evidence favours laparoscopic mesh reinforcement, saving open repair for larger defects. Incarceration was observed in 30.8% of the cases and 2.0% had a recurrence after surgical repair. Hematomas and seromas are common complications, but surgical site infections are relatively rare. Conclusion The high risks of incarceration in lumbar hernias demand a relatively fast elective repair. The use of a mesh is recommended, but the surgical approach should be tailored to individual patient characteristics and risk factors.

This manuscript presents the first case of lumbar hernia repair using a biological mesh. The patient presented with secondary lumbar hernia after surgery for scoliosis. A laparoscopic approach was performed with bovine dermal collagen matrix mesh fixed with cyanoacrylate glue. The patient was followed up to 34 months post-surgery with no evidence of recurrence.

Purpose Traumatic lumbar hernia is rare, thus making diagnosis and proper treatment challenging. Accordingly, we aimed to investigate the clinical manifestations and proper management strategies of traumatic lumbar hernias. Methods The medical records of patients with traumatic lumbar hernia treated at Gachon University Gil Hospital from March 2006 to February 2015, were retrospectively reviewed. Results We included 5 men and 4 women (mean age, 55 years; range, 23-71 years). In 8 patients, most injuries were caused by motor vehicle collisions, including those wherein a pedestrian was struck (5 cases of car accidents, 2 falls, and 1 involving penetrating materials); in 1 patient, the probable cause was severe cough. Eight patients underwent hernia repair surgery (5 open and 3 laparoscopic), and a prosthetic mesh was used in 7 patients. Hernia repairs were elective in 7 patients; emergency hernia repair was performed with right hemicolectomy in 1 patient. No severe complication or recurrence was observed. Only 2 patients had mild complications, such as postoperative seroma. Conclusion Traumatic lumbar hernia is a relatively rare injury of the posteriolateral abdominal wall. Lumbar hernia should be suspected in patients with high-energy injuries of the torso, and all such patients should undergo abdominopelvic computed tomography. After diagnosis, hernia repair can be electively performed without complications in most cases.

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].

Aim This study reports a successful minilaparoscopic treatment of a 62 years old male patient with a Grynfeltt hernia, and outlines a new minimally invasive way to do the procedure. A patient presented with a left lumbar herniation of two years duration with no other symptoms. Physical examination showed a 5 cm soft mass on the left lumbar region, which was confirmed as a hernia by an ultrasound. Method A minilaparoscopic approach to surgery was chosen, using a 10 mm trocar inserted in the umbilical region for pneumoperitoneum and the optics, a 3 mm minilaparoscopy trocar inserted in the preperitoneal region in the left iliac region and another 3 mm trocar inserted more dorsally in the lumbar region. Results The polypropylene mesh was placed in the preperitoneal space without need for any mesh fixation. The total time of surgery was 41 min and the patient was discharged on the next day. Conclusion The proposed novel approach is not only feasible, but offers advantages as it appears to be safer, less invasive, cost-effective and above all eminently reproducible.

Defects of the posterolateral abdominal wall of the abdomen, lumbar hernias are rare. They represent 2% to 3% of hernias of the abdominal wall. This rarity explains the large number of short series and the absence of a well-defined therapeutic modality in the publications. Grynfeltt’s hernia at the top and Jean Louis Petit’s at the bottom are the two entities. The old lumbar hernias are bulky with a rich history and easy diagnosis. Though young, they are discreet and reveal most often by their strangulation. We report the case of a Grynfeltt hernia revealed by colonic occlusion in a 77-year-old woman who had a superior right posteriolateral tumefaction for 15 years. The hernia cure was prosthetic made by the sandwich technique. No recurrence was observed after 25 months of follow-up. Through a review of the literature, we reveal the diagnostic and therapeutic difficulties.

Highlights • Traumatic Lumbar Hernia account for Minority of hernias experienced. • Use of bone anchor fixation allows for restoration of normal anatomy. • Three-point seat-belt is a common cause of traumatic lumbar hernias. • Repair is usually not indicated in the acute setting., Backround Traumatic lumbar hernias are not common hernias that are encountered by general or plastic surgery teams, however it is important to understand the anatomy of the hernia in order to be able to correct the flank defect. In our patient, the oblique muscles were sheared off the iliac crest periosteum, however the attachments to the ribs and spine were maintained. We were able to successfully place a pre-peritoneal polypropylene mesh which was secured to the musculature, and re-approximate the oblique muscles to the iliac crest using Mitek QUICKANCHOR® sutures. Our case study has been reported in line with the SCARE criteria ([8] Agha et al., 2016). Case Report The subject in our case was a 47-year-old gentleman who was involved in a motor vehicle accident, and sustained a traumatic lumbar hernia due to the 3-point seatbelt he was wearing. He was transported via ambulance to our trauma center. Conclusion Understanding the anatomy and mechanism of injury is the key to reconstructing traumatic lumber hernias. Although not required, mesh reinforcement has significantly reduced the recurrence of all hernias. This is the simplest and most effective way, in our opinion, to return the flank muscles to their native position while providing mesh reinforcement.

Lumbar hernia arises through posterolateral abdominal wall defects either through superior lumbar triangle [Grynfeltt-Lesshaft] or inferior lumbar triangle [Petit]. Most of the lumbar hernias are secondary to trauma or previous surgery. Few cases have been reported in literature. We report a case of post traumatic right Inferior triangle hernia of Petit in a 29-year-old healthy male. The hernial defect was closed with 2 layered procedure - sublay and onlay with polypropylene mesh, owing to a big defect and thin abdominal wall muscles. Patient recovered well. Our two layered open meshplasty have been effective, safe and presents with good post-operative recovery. The patient was followed up regularly and there was no recurrence even after 1 year.

The purpose of this study is to describe a specific type of blunt traumatic mesenteric injury called a bucket-handle tear, review its varied CT appearances, and discuss the role of CT in its detection.A bucket-handle mesenteric injury is a rare but life-threatening blunt traumatic injury that can be difficult to detect prospectively on CT and for which delays in diagnosis and definitive surgical management can result in poor outcomes.

Localization of the correct vertebral level for surgical entry during lumbar hernia surgery is not straightforward. In this paper, we develop and evaluate a solution using free-hand 2-D ultrasound (US) imaging in the operation room (OR). Our system exploits the difference in spinous process shapes of the vertebrae. The spinous processes are pre-operatively outlined and labeled in a lateral lumbar X-ray of the patient. Then, in the OR the spinous processes are imaged with 2-D sagittal US, and are automatically segmented and registered with the X-ray shapes. After a small number of scanned vertebrae, the system robustly matches the shapes, and propagates the X-ray label to the US images. The main contributions of our work are: we propose a deep convolutional neural network-based bone segmentation algorithm from US imaging that outperforms state of the art methods in both performance and speed. We present a matching strategy that determines the levels of the spinal processes being imaged. And lastly, we evaluate the complete procedure on 19 clinical data sets from two hospitals, and two observers. The final labeling was correct in 92% of the cases, demonstrating the feasibility of US-based surgical entry point detection for spinal surgeries.

Lumbar hernias develop through the weakening of the posterolateral abdominal wall associated with the Petit's triangle or the Grynfeltt-Lesshaft triangle. Clinicians are generally unfamiliar with the presentation of lumbar hernias, which frequently leads to misdiagnosis and delay of treatment. Prompt failure to diagnose and surgically correct lumbar hernias have resulted in increased morbidity. This review addresses the anatomical and clinical concepts associated with the bilateral costoiliac spaces, which may be implicated in the increased prevalence of left-sided hernias. Knowledge of the contents and boundaries of this enclosure can aid the physician in diagnosis. We explore the intraperitoneal and retroperitoneal diseases that present at the lumbocostal space, including lumbar hernias, which can be classified as congenital, acquired, traumatic, or iatrogenic in origin. In an evaluation, imaging is crucial for assessing musculofascial layer disruptions and hernia contents. Open and laparoscopic surgery, as well retromuscular lumbar hernia repair, are options to explore in surgical intervention, particularly if there are challenges in preliminary pain management. Keywords: Lumbar hernia, Costoiliac spaces, Petit's triangle, Grvnfeltt-lesshaft triangle, Lumbocostovertebral syndrome