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Girerd R, Le Bihan R. Hernie digestive lombaire. ANNALES FRANCAISES DE MEDECINE D URGENCE 2021. [DOI: 10.3166/afmu-2021-0333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Van Cleven S, Claes K, Vanlander A, Van Landuyt K, Berrevoet F. Incisional lumbar hernia after the use of a lumbar artery perforator flap for breast reconstruction. Acta Chir Belg 2020; 120:274-278. [PMID: 32698719 DOI: 10.1080/00015458.2018.1541219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
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.
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Affiliation(s)
- Stijn Van Cleven
- Department of General, Hepatobiliary Surgery and Liver Transplantation Service, Ghent University Hospital, Ghent, Belgium
| | - Karel Claes
- Department of Plastic Surgery, Ghent University Hospital, Ghent, Belgium
| | - Aude Vanlander
- Department of General, Hepatobiliary Surgery and Liver Transplantation Service, Ghent University Hospital, Ghent, Belgium
| | | | - Frederik Berrevoet
- Department of General, Hepatobiliary Surgery and Liver Transplantation Service, Ghent University Hospital, Ghent, Belgium
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Mehrabi S, Yavari Barhaghtalab MJ, Babapour M. Renal pelvis and ureteropelvic junction incarceration in a Grynfeltt-Lesshaft hernia: a case report and review of the literature. BMC Urol 2020; 20:74. [PMID: 32586385 PMCID: PMC7318462 DOI: 10.1186/s12894-020-00626-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 05/05/2020] [Indexed: 11/21/2022] Open
Abstract
Background Grynfeltt–Lesshaft hernia is a kind of lumbar abdominal wall hernia in which clinical presentations may vary from an asymptomatic bulge in the lumbar area to a symptomatic lumbar mass with back pain. It has been accepted to be a rare entity, and incarceration of the kidney through this hernia is shown to be very rare, and very few previous cases have been reported in this regard. We present a case of renal pelvic and ureteropelvic junction incarceration in a Grynfeltt-Lesshaft hernia and provide an overview of the existing literature on it. Case presentation A 76-year-old lady presented to the outpatient clinic with the chief complaint of right flank pain and swelling. Computed tomography (CT) scan of the abdomen was revealed a large herniated sac (60*30 mm) in the upper lumbar triangle with protrusion of retroperitoneal and omental fat, right renal pelvis, ureteropelvic junction and proximal ureter with consecutive hydronephrosis. Herniated retroperitoneal and omental fat was reduced, and closure of the abdominal wall defect was done using retro-muscular Mesh and was fixed to the fascia. The patient was discharged 24 h after the surgery without any complications. Conclusion Kidney herniation through the lumbar triangle is extremely rare, and the diagnosis requires careful clinical evaluation. CT scan is the modality of choice for the assessment. Management through surgery should be done in symptomatic patients.
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Affiliation(s)
- Saadat Mehrabi
- Department of General Surgery, Shahid Beheshti Hospital, Yasuj University of Medical Sciences, Yasuj, Iran
| | | | - Mehdi Babapour
- Department of General Surgery, Shahid Beheshti Hospital, Yasuj University of Medical Sciences, Yasuj, Iran
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Piozzi GN, Cirelli R, Maino MEM, Lenna G. Management Criteria of Grynfeltt's Lumbar Hernia: A Case Report and Review of Literature. Cureus 2019; 11:e3865. [PMID: 30899616 PMCID: PMC6414194 DOI: 10.7759/cureus.3865] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Grynfeltt's lumbar hernia is a rare abdominal wall pathology with around 300 cases described in the literature. Recently, a therapeutically aimed classification was proposed analysing the size, location, contents, muscular atrophy, origin, and existence of the previous recurrence. Surgical repair is the only definitive treatment option through either an open or laparoscopic approach. An 87-year-old female came to consult for swelling in the right lumbar area without traumatic history. A smooth, reducible, and tender mass of 4 x 3 cm was described. The suspicion of a Grynfeltt's hernia was confirmed by lumbar ultrasound with evidence of a 10 mm abdominal wall defect with the diameter increasing to 15 mm during a Valsalva maneuver. The patient had a primary type A lumbar hernia; therefore, open hernioplasty was performed. The patient was discharged from the hospital on the third postoperative day in optimal clinical condition. Her 12-month follow-up examination was uneventful. A lumbar hernia diagnosis can be challenging. Preoperative imaging has an important role in assessing the size, location, and hernia contents. The use of a therapeutically aimed classification could be useful for optimal patient management and improvement of surgical outcomes.
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Huang DY, Pan L, Chen MY, Fang J. Laparoscopic repair via the transabdominal preperitoneal procedure for bilateral lumbar hernia: Three cases report and review of literature. World J Clin Cases 2018; 6:398-405. [PMID: 30283803 PMCID: PMC6163131 DOI: 10.12998/wjcc.v6.i10.398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 06/22/2018] [Accepted: 06/28/2018] [Indexed: 02/05/2023] Open
Abstract
A lumbar hernia is a rare entity, and a bilateral lumbar hernia is much rarer. From May 2015 to October 2017, we treated only three patients with bilateral lumbar hernias. One patient came to the hospital presenting with right-sided abdominal pain, and the other two patients presented with bilateral lumbar masses. The previous bilateral lumbar hernia reported in the literature was repaired by open surgery. The laparoscopic approach via the transabdominal preperitoneal (TAPP) procedure with the self-gripping Parietex ProGrip™ mesh was performed at our center. The laparoscopic repair was conducted by a skilled hernia surgeon, and was successfully performed in the three patients. The patients resumed a semi-liquid diet and had no activity restriction after six hours following the operation. No antibiotics were used after the surgery. The operative times of the three patients were 120 min, 85 min, and 130 min. The blood loss volumes of the three patients were 20 mL, 5 mL, and 5 mL. The visual analogue scale pain scores of the three patients were 1, 2, and 2 on postoperative day 1, and were 1, 2, and 1 on postoperative day 3. No perioperative complications, such as bulge, wound infection and hematoma, occurred after the surgery. All of the patients were discharged on the third day after the operation. There was no chronic pain and no hernia recurrence during the follow-up. This study showed that the laparoscopic TAPP approach with the self-gripping mesh is safe and feasible, and can be considered an alternative method for the treatment of bilateral lumbar hernias.
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Affiliation(s)
- Di-Yu Huang
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Long Pan
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
- Key Laboratory of Laparoscopic Technique Research of Zhejiang Province, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Ming-Yu Chen
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Jing Fang
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
- Key Laboratory of Laparoscopic Technique Research of Zhejiang Province, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
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Claus CMP, Nassif LT, Aguilera YS, Ramos EB, Coelho JCU. LAPAROSCOPIC REPAIR OF LUMBAR HERNIA (GRYNFELT): TECHNICAL DESCRIPTION. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2018; 30:56-59. [PMID: 28489172 PMCID: PMC5424690 DOI: 10.1590/0102-6720201700010016] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 12/06/2016] [Indexed: 01/10/2023]
Abstract
Background: Lumbar hernias are rare. Usually manifest with reducible volume increase in the post-lateral region of the abdomen and may occur in two specific anatomic defects: the triangles of Grynfelt (upper) and Petit (lower). Despite controversies with better repair, laparoscopic approach, following the same principle of the treatment of inguinal hernias, seems to present significant advantages compared to conventional/open surgeries. However, some technical and anatomical details of the region, non usual to general surgeons, are fundamental for proper repair. Aim: To present systematization of laparoscopic transabdominal technique for repair of lumbar hernias with emphasis on anatomical details. Method : Patient is placed in the lateral decubitus. Laparoscopic access to abdominal cavity is performed by open technique on the left flank, 1.5 cm incision, followed by introduction of 11 mm trocar for a 30º scope. Two other 5 mm trocars, in the left anterior axillary line, are inserted into the abdominal cavity. The peritoneum of the left paracolic gutter is incised from the 10th rib to the iliac crest. Peritoneum and retroperitoneal is dissected. Reduction of all hernia contents is performed to demonstrate the hernia and its size. A 10x10 cm polypropylene mesh is introduced into the retroperitoneal space and fixed with absorbable staples covering the defect with at least 3-4 cm overlap. Subsequently, is carried out the closure of the peritoneum of paracolic gutter. Results: This technique was used in one patient with painful increased volume in the left lower back and bulging on the left lumbar region. CT scan was performed and revealed left superior lumbar hernia. Operative time was 45 min and there were no complications and hospitalization time of 24 h. Conclusion: As in inguinal hernia repair, laparoscopic approach is safe and effective for the repair of lumbar hernias, especially if the anatomical details are adequately respected.
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Affiliation(s)
- Christiano Marlo Paggi Claus
- Nossa Senhora das Graças Hospital.,Service of Digestive System Surgery and Jacques Perissat Institute, Universidade Positivo, Curitiba, PR, Brazil
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Luo P, HE XW, Chen QY, Hong H, Yang L. Femoral Intertrochanteric Fracture With Spontaneous Lumbar Hernia: A Case Report. Trauma Mon 2016; 21:e25132. [PMID: 28184361 PMCID: PMC5292020 DOI: 10.5812/traumamon.25132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 12/31/2014] [Accepted: 01/10/2015] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION The diagnosis of lumbar hernia can be easily missed, as it is a rare case to which most orthopedists are not exposed in their common clinical practice. Approximately 300 cases have been reported in the literature since it was first described by Barbette in 1672. CASE PRESENTATION A 76-year-old woman who had been diagnosed with a femoral intertrochanteric fracture was sent to our department. Physical examination revealed a smooth, soft, and movable mass, with no tenderness, palpable on her left flank, which had gradually increased during the last seven years and presented with a slight feeling of swelling. We initially misdiagnosed the case as a left lipoma combined with the femoral intertrochanteric fracture. However, after six hours, the patient presented with a sudden onset of nausea, vomiting, and abdominal distension. Afterward, computed tomography (CT) examination confirmed that the mass was a spontaneous lumbar hernia. CONCLUSIONS A lumbar hernia may, on rare occasions, become incarcerated or strangulated, with the consequent complication of mechanical bowel obstruction. We suggest that a patient with a flank mass should always raise suspicions of a lumbar hernia.
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Affiliation(s)
- Peng Luo
- Department of Orthopaedics, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xing-Wen HE
- Department of Orthopaedics, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qing-Yun Chen
- Department of Orthopaedics, The Third People’s Hospital of Cangnan, Wenzhou, China
| | - Hao Hong
- Department of Orthopaedics, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Lei Yang
- Department of Orthopaedics, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Corresponding author: Lei Yang, Department of Orthopaedics, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China. Tel: +86-57788002809, Fax: +86-57788002823, E-mail:
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Grynfeltt Hernia: A Deceptive Lumbar Mass with a Lipoma-Like Presentation. Case Rep Surg 2015; 2015:954804. [PMID: 26697256 PMCID: PMC4677172 DOI: 10.1155/2015/954804] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 10/25/2015] [Indexed: 11/17/2022] Open
Abstract
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.
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Alcoforado C, Lira N, Kreimer F, Martins-Filho ED, Ferraz AAB. Grynfelt hernia. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2014; 26:241-3. [PMID: 24190386 DOI: 10.1590/s0102-67202013000300017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Xu T, Zhang S, Wang H, Yu W. Lumbar hernia associated with chronic obstructive pulmonary disease (COPD). Pak J Med Sci 2013. [PMID: 24353649 DOI: 10.12669/pjms.293.3232] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Lumbar hernias are very rare posterolateral abdominal wall hernias, and they are spontaneous in most adult patients. Here we report two cases of spontaneous lumbar hernias associated with chronic obstructive pulmonary disease (COPD). Some factors such as chronic cough, poor nutritional status and old age in patients with COPD would contribute to lumbar hernia.
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Affiliation(s)
- Tao Xu
- Tao Xu, MD, Department of Respiration, The People's Hospital of Yinzhou, The Affiliated Yinzhou Hospital, Ningbo University, 251 Baizhang East Road, Ningbo, Zhejiang, 315040, The People's Republic of China
| | - Shuwei Zhang
- Shuwei Zhang, MD, Department of Urological Surgery, The No.2 Hospital of Yinzhou, 1 Qianhe Road, Ningbo, Zhejiang, 315040, The People's Republic of China
| | - Huaying Wang
- Huaying Wang, MD, PhD, Department of Respiration, The People's Hospital of Yinzhou, The Affiliated Yinzhou Hospital, Ningbo University, 251 Baizhang East Road, Ningbo, Zhejiang, 315040, The People's Republic of China
| | - Wanjun Yu
- Wanjun Yu, MD, PhD, Department of Respiration, The People's Hospital of Yinzhou, The Affiliated Yinzhou Hospital, Ningbo University, 251 Baizhang East Road, Ningbo, Zhejiang, 315040, The People's Republic of China
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Coulier B, Gogoase M, Ramboux A, Pierard F. Extra-abdominal lumbar abscesses caused by retroperitoneal gastrointestinal perforations through the lumbar triangle of Petit: report of two cases diagnosed by CT. ACTA ACUST UNITED AC 2013; 37:1122-8. [PMID: 22270582 DOI: 10.1007/s00261-012-9847-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Extra-abdominal abscesses of gastrointestinal origin developing within the lumbar subcutaneous tissues are extremely rare. We report two cases of retroperitoneal bowel perforation presenting spontaneously at admission with a lumbar abscess trespassing the lumbar triangle of Petit, a classical "locus of minus resistencia" of the posterior abdominal wall. The first case was caused by perforation of a retrocecal appendicitis--being concomitantly responsible of a necrotizing fasciitis of the thigh--and in the second case perforation was caused by left colonic diverticulitis. In both cases, the full diagnosis was made with abdominal CT. The patients were threatened by a two-step surgical approach comprising a direct posterior percutaneous drainage of the abscess followed by classical laparotomy.
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Affiliation(s)
- Bruno Coulier
- Department of Diagnostic Radiology, Clinique St Luc, Rue St Luc 8, 5004 Bouge, Namur, Belgium.
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Suarez S, Hernandez JD. Laparoscopic repair of a lumbar hernia: report of a case and extensive review of the literature. Surg Endosc 2013; 27:3421-9. [PMID: 23636518 DOI: 10.1007/s00464-013-2884-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Accepted: 02/15/2013] [Indexed: 01/10/2023]
Abstract
Lumbar hernias are a protrusion of intra-abdominal contents through a weakness or rupture in the posterior abdominal wall. They are considered to be a rare entity with approximately 300 cases reported in the literature since it was first described by Barbette in 1672. Petit described the inferior lumbar triangle in 1783 and Grynfeltt described the superior lumbar triangle in 1866; both are anatomical boundaries where 95% of lumbar hernias occur, whereas the other 5% are considered to be diffuse. Twenty percent of lumbar hernias are congenital and the other 80% are acquired; the acquired lumbar hernias can be further classified into either primary (spontaneous) or secondary. The typical presentation of lumbar hernias is a patient with a protruding semispherical bulge in the back with a slow growth. However, they may present with an incarcerated or strangulated bowel, so it is recommended that all lumbar hernias must be repaired as soon as they are diagnosed. The "gold standard" for diagnosing a lumbar hernia is a CT scan, because it is able to delineate muscular and fascial layers, detect a defect in one or more of these layers, evaluate the presence of herniated contents, differentiate muscle atrophy from a real hernia, and serve as a useful tool in the differential diagnosis, such as tumors. Recent studies have demonstrated the advantages of a laparoscopic repair instead of the classic open approach as the ideal treatment option for lumbar hernias. We report a case of a spontaneous lumbar hernia initially diagnosed as a lipoma and corrected with the open approach, but after relapsing 2 years later it was corrected using a laparoscopic approach. It is followed by an extensive review of lumbar hernias literature regarding history, anatomy, and surgical techniques.
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Affiliation(s)
- Sebastian Suarez
- School of Medicine, Universidad de Andes, Department of Surgery, Hospital Universitario Fundación Santa Fe de Bogota, Carrera 7 No 116-05, Cuarto Piso, Bogotá, Colombia
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Zhou X, Zhang J, Hu H. Kugel patch repair of superior lumbar hernias. Hernia 2013; 18:601-5. [DOI: 10.1007/s10029-013-1056-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Accepted: 02/08/2013] [Indexed: 11/29/2022]
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Armstrong O, Frampas E. An exceptional post-traumatic double hernia. Hernia 2012; 17:145-7. [PMID: 22976510 DOI: 10.1007/s10029-012-0985-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 08/24/2012] [Indexed: 11/26/2022]
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Moreno-Egea A, Alcaraz AC, Cuervo MC. Surgical options in lumbar hernia: laparoscopic versus open repair. A long-term prospective study. Surg Innov 2012; 20:331-44. [PMID: 22956401 DOI: 10.1177/1553350612458726] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To determine the safety and effectiveness of laparoscopic lumbar hernia repair. DESIGN Prospective clinical study. SETTING Abdominal wall unit, university hospital. PATIENTS Between January 1995 and December 2008, data from 55 consecutive patients who had undergone laparoscopic (n = 35) or open (n = 20) lumbar hernia repair. MAIN OUTCOME MEASURES The primary endpoint was recurrence; secondary endpoints were patient outcomes (morbidity, pain, and return to normal activity). RESULTS Mean operating time (P = .01), hospital stay, return to normal activity, analgesic consumption, and pain at 1 month (P < .001) were significantly less in the laparoscopic group. Complications were similar in the 2 groups (37% vs 40%, respectively; P = .50). Traumatic hernias increased local complications versus incisional lumbar hernias (71.4% vs 29%; P = .007). Consumption of analgesics (6.8 ± 6.5 vs 18.1 ± 9.1; P < .001) and pain during the first month (no pain: 90% vs 54.3%; P = .015) were significantly less with a lightweight versus medium-weight mesh. The risk factors associated with recurrences development were localization (P = .01) and size (P = .008). Recurrence rates were 2.9% in the laparoscopic group and 15% in the open group (P = .13). CONCLUSIONS Outcomes did not differ with respect to morbidity and recurrence rate after long-term follow-up; however, this study suggested that laparoscopic approach for lumbar hernia is safe, effective, and more efficient than open repair and can be considered the procedure of choice. Open surgery may be considered the best option in the diffuse hernias with size larger than 15 cm.
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Schuenke MD, Vleeming A, Van Hoof T, Willard FH. A description of the lumbar interfascial triangle and its relation with the lateral raphe: anatomical constituents of load transfer through the lateral margin of the thoracolumbar fascia. J Anat 2012; 221:568-76. [PMID: 22582887 DOI: 10.1111/j.1469-7580.2012.01517.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Movement and stability of the lumbosacral region is contingent on the balance of forces distributed through the myofascial planes associated with the thoracolumbar fascia (TLF). This structure is located at the common intersection of several extremity muscles (e.g. latissimus dorsi and gluteus maximus), as well as hypaxial (e.g. ventral trunk muscles) and epaxial (paraspinal) muscles. The mechanical properties of the fascial constituents establish the parameters guiding the dynamic interaction of muscle groups that stabilize the lumbosacral spine. Understanding the construction of this complex myofascial junction is fundamental to biomechanical analysis and implementation of effective rehabilitation in individuals with low back and pelvic girdle pain. Therefore, the main objectives of this study were to describe the anatomy of the lateral margin of the TLF, and specifically the interface between the fascial sheath surrounding the paraspinal muscles and the aponeurosis of the transversus abdominis (TA) and internal oblique (IO) muscles. The lateral margin of the TLF was exposed via serial reduction dissections from anterior and posterior approaches. Axial sections (cadaveric and magnetic resonance imaging) were examined to characterize the region between the TA and IO aponeurosis and the paraspinal muscles. It is confirmed that the paraspinal muscles are enveloped by a continuous paraspinal retinacular sheath (PRS), formed by the deep lamina of the posterior layer of the TLF. The PRS extends from the spinous process to transverse process, and is distinct from both the superficial lamina of the posterior layer and middle layer of the TLF. As the aponeurosis approaches the lateral border of the PRS, it appears to separate into two distinct laminae, which join the anterior and posterior walls of the PRS. This configuration creates a previously undescribed fat-filled lumbar interfascial triangle situated along the lateral border of the paraspinal muscles from the 12th rib to the iliac crest. This triangle results in the unification of different fascial sheaths along the lateral border of the TLF, creating a ridged-union of dense connective tissue that has been termed the lateral raphe (Spine, 9,1984, 163). This triangle may function in the distribution of laterally mediated tension to balance different viscoelastic moduli, along either the middle or posterior layers of the TLF.
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Affiliation(s)
- M D Schuenke
- Department of Anatomy, University of New England College of Osteopathic Medicine, Biddeford, ME 04005, USA.
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MDCT of abdominal wall lumbar hernias: anatomical review, pathologic findings and differential diagnosis. Surg Radiol Anat 2012; 34:455-63. [PMID: 22307689 DOI: 10.1007/s00276-012-0937-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Accepted: 01/13/2012] [Indexed: 10/14/2022]
Abstract
PURPOSE To review the anatomical landmarks of the abdominal wall lumbar region and its normal appearance on multidetector computed tomography (MDCT) and to briefly describe the MDCT features of lumbar hernias. METHODS We performed a retrospective search of the imaging report database from November 2007 to October 2011. We retrieved the clinical data and MDCT studies of patients suffering from abdominal wall lumbar hernias. We reviewed the imaging features of abdominal lumbar hernias and compared those with the normal appearance of the lumbar region in asymptomatic individuals. RESULTS We classified lumbar wall hernias as diffuse, superior (or Grynfelt-Lesshaft) and inferior (or Petit) lumbar hernias. We briefly describe the imaging features of each subtype and review the anatomy and MDCT appearance of normal lumbar region. CONCLUSIONS Currently available MDCT provides an excellent opportunity for reviewing the normal anatomy of the wall lumbar region and may be considered a useful modality for evaluating lumbar hernias.
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Tobias-Machado M, Araújo FBCD, Castro-Neves O, Correa WF, Mitre AI, Pompeo ACL. Laparoendoscopic single-site (LESS) repair of lumbar hernia: initial case report. Clinics (Sao Paulo) 2012; 67:89-91. [PMID: 22249487 PMCID: PMC3248608 DOI: 10.6061/clinics/2012(01)15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Lillie GR, Deppert E. Inferior lumbar triangle hernia as a rarely reported cause of low back pain: a report of 4 cases. J Chiropr Med 2011; 9:73-6. [PMID: 21629553 DOI: 10.1016/j.jcm.2010.02.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2009] [Revised: 01/21/2010] [Accepted: 02/03/2010] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE Lumbar triangle hernias are rarely reported causes of low back pain. We describe the symptoms, signs, and anatomical location of 2 possible defects in the posterior abdominal wall where lumbar hernias may appear. The clinical diagnosis was challenging, and advanced imaging failed to initially uncover the conditions. CLINICAL FEATURES We report 4 patients with spontaneous inferior lumbar triangle hernias (Petit triangle hernias) initially presenting to a primary care clinic with the primary complaint of low back pain. INTERVENTION AND OUTCOMES Thorough histories and examinations led to successful outcomes. All 4 patients were operated on to correct the defect. No recurrence has occurred. CONCLUSIONS Anatomical knowledge and clinical acumen led to correct diagnosis of these rare lumbar hernias. This information should help both medical and chiropractic clinicians detect these conditions, and aid in appropriate management.
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Affiliation(s)
- Gregory R Lillie
- Contracted Chiropractic Physician, Naval Hospital Pensacola, Naval Branch Health Clinic NATTC, Pensacola, FL 32508
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Does the Latissimus dorsi insert on the iliac crest in man? Anatomic and ontogenic study. Surg Radiol Anat 2011; 33:751-4. [PMID: 21503654 DOI: 10.1007/s00276-011-0812-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Accepted: 04/01/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The Latissimus dorsi muscle is usually considered as inserted on the iliac crest, but it is separated from it by the thoracolumbar fascia. In our experience based on the harvesting of pedicled Latissimus dorsi flaps to cover cervicofacial loss of substances, we have found that in some cases, the muscular fibers of the anterior border of the muscle are directly inserted on the iliac crest. In these cases, the harvesting of the flap could be more distal. METHODS To determine whether this direct muscular insertion is frequent or not, we performed dissections on 30 fresh cadavers of the lower insertion of the Latissimus dorsi muscle, and 6 dissections of human fetuses to study the ontogeny of these insertions. RESULTS The Latissimus dorsi muscle presented direct muscular insertions on the iliac crest in 13.33% of cases. The fetal dissections showed that before 30 weeks of development, the anterior part of the muscle was directly inserted on the iliac crest, and after it was separated from it by the thoracolumbar fascia. Although the harvesting of the Latissimus dorsi in continuity with the thoracolumbar fascia has been described in pedicled flaps, it is usually considered that it is impossible to harvest Latissimus dorsi musculocutaneous flaps in contact with the iliac crest, because there are no perforating vessels from the thoracolumbar fascia to the skin. According to our results, in some cases, it could be possible to harvest a pedicled musculo-cutaneous LD flap more distal that it is usually described.
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Kawaguchi M, Ishikawa N, Shimizu S, Shin H, Matsunoki A, Watanabe G. Single incision endoscopic surgery for lumbar hernia. MINIM INVASIV THER 2010; 20:62-4. [DOI: 10.3109/13645706.2010.518691] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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22
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Lee S, Chang HJ, Lee LH, Hong YR, Jung SW, Kim SK, Chung CW. Superior Lumbar Hernia. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2010. [DOI: 10.4174/jkss.2010.78.1.62] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Sol Lee
- Department of Surgery, College of Medicine, CHA University, Seongnam, Korea
| | - Ho Jin Chang
- Department of Surgery, College of Medicine, CHA University, Seongnam, Korea
| | - Lee Hoh Lee
- Department of Surgery, College of Medicine, CHA University, Seongnam, Korea
| | - Young Ran Hong
- Department of Surgery, College of Medicine, CHA University, Seongnam, Korea
| | - Sung Woo Jung
- Department of Surgery, College of Medicine, CHA University, Seongnam, Korea
| | - Seung Ki Kim
- Department of Surgery, College of Medicine, CHA University, Seongnam, Korea
| | - Chul Woon Chung
- Department of Surgery, College of Medicine, CHA University, Seongnam, Korea
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23
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Cavallaro G, Sadighi A, Paparelli C, Miceli M, D'Ermo G, Polistena A, Cavallaro A, De Toma G. Anatomical and Surgical Considerations on Lumbar Hernias. Am Surg 2009. [DOI: 10.1177/000313480907501217] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Lumbar hernias, which are rare hernias of the posterolateral abdominal wall, can be divided into two groups: primary lumbar hernias, often the expression of a congenital defect, which typically arise in two areas of weakness, the superior triangle and inferior triangle and acquired (or diffuse) lumbar hernias which are usually due to previous lumbar trauma or surgery. Clinical examination may be adjuvated by ultrasound or CT scan, which can reveal the abdominal wall defect with the hernia content (viscera or extraperitoneal tissue). Surgical repair of lumbar hernias, both primary and acquired, has rapidly developed through recent years, similarly to the treatment of more frequent kinds of hernia (groin, epigastric), evolving from direct repair to mini-invasive techniques, even if, since the rarity of these hernias, precise knowledge of this complex anatomic region is required. Nowadays there are two valid alternatives: open tension-free repair (with use of mesh), and mini-invasive repair. Both are safe and effective, even if smaller hernias can be treated by open approach, with loco-regional anesthesia and good cosmetic effect. Larger hernias, or hernias with suspected viscera involvement, should require larger incisions and viscera exploration. For this reason laparoscopic access would be preferable.
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Affiliation(s)
- Giuseppe Cavallaro
- Department of Surgery, “P. Valdoni,” Policlinico Umberto I, “Sapienza” University, Rome, Italy
| | | | - Claudia Paparelli
- Department of Surgery, “P. Valdoni,” Policlinico Umberto I, “Sapienza” University, Rome, Italy
| | | | - Giuseppe D'Ermo
- Department of Surgery, “P. Valdoni,” Policlinico Umberto I, “Sapienza” University, Rome, Italy
| | - Andrea Polistena
- Department of Surgery, “P. Valdoni,” Policlinico Umberto I, “Sapienza” University, Rome, Italy
| | - Antonino Cavallaro
- Department of Surgery, “P. Valdoni,” Policlinico Umberto I, “Sapienza” University, Rome, Italy
| | - Giorgio De Toma
- Department of Surgery, “P. Valdoni,” Policlinico Umberto I, “Sapienza” University, Rome, Italy
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24
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Incarcerated small bowel within a spontaneous lumbar hernia. Hernia 2009; 14:539-41. [PMID: 19890674 DOI: 10.1007/s10029-009-0581-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2009] [Accepted: 10/16/2009] [Indexed: 10/20/2022]
Abstract
Lumbar hernias are rare, resulting from protrusion through the posterior abdominal wall that may be congenital, acquired or spontaneous. They very rarely present with acute bowel obstruction. We present a case of incarcerated small bowel within a spontaneous inferior (Petit's) lumbar hernia, treated by early open repair with mesh insertion. This case highlights the importance of thorough clinical examination and a high index of suspicion, even in the absence of previous surgery around the anatomical site of the suspected hernia, in order to effect an early repair before the onset of ischaemia in incarcerated contents.
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25
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A very simple technique to repair Grynfeltt–Lesshaft hernia. Hernia 2009; 14:439-41. [DOI: 10.1007/s10029-009-0566-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2009] [Accepted: 09/18/2009] [Indexed: 02/04/2023]
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26
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Chung M. Post-traumatic Lumbar Hernia Repaired with PHS (Prolene Hernia System). JOURNAL OF THE KOREAN SURGICAL SOCIETY 2009. [DOI: 10.4174/jkss.2009.77.3.221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Min Chung
- Department of Surgery, Gil Hospital, Gachon University of Medicine and Science, Incheon, Korea
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Park CY, Hur YH, Kim JC, Kim SK. Recurrence after Repair of Primary Acquired Grynfeltt Hernia. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2009. [DOI: 10.4174/jkss.2009.77.2.149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Chan Yong Park
- Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Young Hoe Hur
- Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Jung Chul Kim
- Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Shin Kon Kim
- Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
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Armstrong O. Lumbar hernia: anatomical basis and clinical aspects. Surg Radiol Anat 2008; 31:317. [PMID: 19037579 DOI: 10.1007/s00276-008-0440-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2008] [Accepted: 10/31/2008] [Indexed: 11/24/2022]
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29
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Lumbar hernia, anatomical basis and clinical aspects. Surg Radiol Anat 2008; 30:609-10. [PMID: 18654735 DOI: 10.1007/s00276-008-0396-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Accepted: 07/02/2008] [Indexed: 01/28/2023]
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