Petit lumbar hernia--a double-layer technique for tension-free repair

Primary Lumbar Hernia, Review and Proposals for a Standardized Treatment

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.

Primary Grynfeltt's hernia combined with intermuscular lipoma: A case report

INTRODUCTION

Grynfeltt's hernia (superior lumbar hernia) is a rare posterolateral abdominal wall defect and is often misdiagnosed as an abdominal wall lipoma. I recently experienced a case of primary Grynfeltt's hernia combined with intermuscular lipoma that was managed surgically.

PRESENTATION OF CASE

A 79-year-old man presented with a left flank mass. In the seated position, when the abdominal pressure was raised by deep breathing after left flank extension, the mass became clearer. Abdominal computed tomography (CT) findings showed herniated perirenal fat via the superior lumbar triangle and a surrounding intermuscular lipoma. After intermuscular lipoma removal, the hernia defect was closed with primary simple interrupted sutures. Currently, at 5 months postoperatively, no recurrence has been observed.

DISCUSSION

On physical examination of Grynfeltt's hernia, it may be difficult to identify the distinct mass because of the relatively large overlaying of the latissimus dorsi muscle. Thus, Grynfeltt's hernia can be misdiagnosed as soft tissue tumors, such as lipomas. Abdominal CT findings may provide an accurate diagnosis and reveal the anatomical structures and additional lesions. Proper surgical treatment should be planned based on the etiology, size of the hernia defect, condition of the surrounding structures, and presence of additional lesions.

CONCLUSION

Grynfeltt's hernia should be considered when a mass is palpable on the posterolateral abdominal wall and in cases where the size of the mass changes when changing position. CT examination of the abdomen may help make an accurate diagnosis, observe additional lesions, and develop a surgical-treatment plan.

Bilateral Fat Containing Lumbar Hernia: A Case Report and Literature Review

Patient: Female, 84

Final Diagnosis: Bilateral fat containing lumbar hernia

Symptoms: Abdominal pain

Medication: —

Clinical Procedure: —

Specialty: Surgery

Pitfalls and clinical recommendations for the primary lumbar hernia based on a systematic review of the literature

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.

Primary Jean Louis Petit and Grynfeltt-Lesshaft concomitant hernias: A case report

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Primary lumbar hernia.

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Concomitant lumbar hernias : Jean Louis Petit and Grynfeltt-Lesshaft.

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Misdiagnosis hernia.

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Surgical approach.

Introduction

Posterior abdominal wall hernias are rare, mainly post traumatic or post-operative. This case is particular first by its mechanism, it is a primary lumbar hernia and secondly it is a concomitant hernia of the Jean Louis Petit triangle and the Grynfeltt triangle.

Presentation of case

The patient was a 67 years old man, a former farmer. He complaint of a painful tumefaction on his back evolving for the last 2 years. After clinical examination, a diagnosis of lumbar hernia was retained. The CT scan which is the gold standard was not performed due to financial limitations. An hernioplasty with a porcine collagen mesh was done, in per operative we found a Jean Louis Petit hernia and a Grynfeltt-Lesshaft hernia. Any post-operative complications.

Discussion

Lumbar hernia is not a common diagnosis, and most of time is misdiagnosed. Acquired primary lumbar hernia can be due to profession involving lumbar constraints leading to the weakness of muscles. This was the case of our patient. Another particularity was the double hernia, the upper and lower lumbar triangles. We already know the impact of his profession and may be 20 years of this leaded to the double hernia? An hernioplasty in open surgery was proposed for multiples reasons: the age of the patient, the weakness of the muscle, a large exploration of the hernia, to reinforce the posterior lumbar wall and to prevent a recidivism.

Conclusion

Jean Louis Petit and Grynfeltt-Lesshaft hernias are very uncommon. Few cases have been reported.

A rare case of a superior lumbar hernia secondary to penetrating injury

Lumbar hernias are rare occurrences, with only 300 cases reported in the literature. We present a unique case of a superior lumbar hernia secondary to penetrating trauma to the right flank. We performed a herniorrhaphy using porcine mesh, and provided additional support by mobilizing the external oblique and latissimus dorsi into the defect. At follow up three months after repair, the patient was asymptomatic and exam revealed an intact lumbar abdominal wall with normal contour. Although literature displays a consensus on the need for lumbar hernia repair, specific repair techniques must be tailored to defect etiology, size, location, and contents.

Grynfeltt Hernia: A Deceptive Lumbar Mass with a Lipoma-Like Presentation

The Grynfeltt-Lesshaft hernia is a rare posterior abdominal wall defect that allows for the herniation of retro- and intraperitoneal structures through the upper lumbar triangle. While this hernia may initially present as a small asymptomatic bulge, the defect typically enlarges over time and can become symptomatic with potentially serious complications. In order to avoid that outcome, it is advisable to electively repair Grynfeltt hernias in patients without significant contraindications to surgery. Due to the limited number of lumbar hernioplasties performed, there has not been a large study that definitively identifies the best repair technique. It is generally accepted that abdominal hernias such as these should be repaired by tension-free methods. Both laparoscopic and open techniques are described in modern literature with unique advantages and complications for each. We present the case of an unexpected Grynfeltt hernia diagnosed following an attempted lipoma resection. We chose to perform an open repair involving a combination of fascial approximation and dual-layer polypropylene mesh placement. The patient's recovery was uneventful and there has been no evidence of recurrence at over six months. Our goal herein is to increase awareness of upper lumbar hernias and to discuss approaches to their surgical management.

Lumbar (Petit's) hernia: A rare entity

Lumbar hernias are rare and diagnostically challenging for surgeons. We present the case of a middle-aged patient who presented with swelling in the left back. Subcutaneous lipoma was included in the differential diagnosis. Following diagnostic studies, computed tomography confirmed left lumbar hernia. Elective surgery was performed, and the results revealed Petit's hernia. The hernia was repaired with mesh.