1
|
Zhang Y, Wu W, Wang T, Si X, Huang L, Tang R, Liu N. Single-Incision Laparoscopic Totally Extraperitoneal Sublay Repair of Lumbar Hernia: A Novel Technique. J Laparoendosc Adv Surg Tech A 2024. [PMID: 39150373 DOI: 10.1089/lap.2024.0174] [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: 08/17/2024] Open
Abstract
Background: Lumbar hernia is a rare disease with low incidence, and no golden standard surgical procedure has been established for lumbar hernias. The single-incision laparoscopic totally extraperitoneal sublay (SIL-TES) technique became a novel surgical technique for lumbar hernias. Methods: This retrospective study included 20 patients who underwent SIL-TES repair for lumbar hernia between April 2020 and March 2024. The baseline patient characteristics, intraoperative data, postoperative data, satisfaction score, and Carolina Comfort Scale scores were collected. Results: The results revealed that the SIL-TES technique for lumbar hernia repair is associated with a low complication rate, nonrecurrence, high satisfaction score, and high quality of life after surgery. Conclusions: The SIL-TES technique could be a feasible and effective surgical technique for lumbar hernias. A controlled study is needed for further confirmation.
Collapse
Affiliation(s)
- Yizhong Zhang
- Department of Hernia and Hepatobiliary Surgery, The First Affiliated Hospital of Ningbo University, Zhejiang, China
| | - Weidong Wu
- Gastrointestinal Surgery Department of General Surgery Center, School of Medicine, Shanghai General Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China
| | - Tingfeng Wang
- Department of General Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China
| | - Xianke Si
- Department of Minimally Invasive Surgery, Putuo Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Liangliang Huang
- Department of General Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China
| | | | - Nan Liu
- Department of Hernia and Abdominal Wall Surgery, Shanghai East Hospital, Tongji University, Shanghai, China
| |
Collapse
|
2
|
Heemskerk J, Leijtens JWA, van Steensel S. Primary Lumbar Hernia, Review and Proposals for a Standardized Treatment. JOURNAL OF ABDOMINAL WALL SURGERY : JAWS 2023; 2:11754. [PMID: 38312404 PMCID: PMC10831689 DOI: 10.3389/jaws.2023.11754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 11/15/2023] [Indexed: 02/06/2024]
Abstract
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.
Collapse
Affiliation(s)
- Jeroen Heemskerk
- Department of Surgery, Laurentius Hospital Roermond, Roermond, Netherlands
| | | | | |
Collapse
|
3
|
Chen ZM, Fan XQ, Zhou YX. Retrospective analysis of 16 cases of lumbar hernia. Heliyon 2023; 9:e22235. [PMID: 38045220 PMCID: PMC10692800 DOI: 10.1016/j.heliyon.2023.e22235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 11/04/2023] [Accepted: 11/07/2023] [Indexed: 12/05/2023] Open
Abstract
Background Through a retrospective analysis of 16 cases of lumbar hernia, we discussed the anatomical basis, clinical manifestations, diagnosis, and treatment of this rare condition. Methods We collected medical data of 15 patients with a primary lumbar hernia and one patient with a secondary lumbar hernia treated in the General Surgery Department of Wuxi No.2 People's Hospital between January 2008 and June 2021 and analysed their demographic, preoperative, and postoperative data. Results All patients underwent elective surgery performed by the same treatment team for superior lumbar hernias. The median area of the hernia defect was 12 cm2. Fifteen patients underwent sublay repair, and one underwent onlay repair. The median operative time and blood loss were 48 min and 22 mL, respectively. The hernia contents were extraperitoneal fat in 15 patients and partial small intestine in one. The median visual analogue scale score on postoperative day 1 was 3. A postoperative drainage tube was placed in three cases but not used in 13. The median duration of hospital stay was 5 days. Postoperative incision infection occurred in one case. During the follow-up period, no postoperative complications, including haematoma, seroma, incision infection or rupture, recurrence, and chronic pain, occurred in the other 15 cases. Conclusion Lumbar hernias are rare and can be safely and effectively treated by open tension-free repair.
Collapse
Affiliation(s)
- Zhi-ming Chen
- Department of General Surgery, Jingjiang People's Hospital, the Affiliated Hospital of Jiangsu Vocational College of Medicine, Jingjiang Ctiy, Taizhou, Jiangsu, 214500, China
| | - Xin-qi Fan
- Department of General Surgery, Wuxi NO.2 People's Hospital, Jiangnan University Medical Center, JUMC. Wuxi, Jiangsu, 214000, China
| | - You-xin Zhou
- Department of General Surgery, Wuxi NO.2 People's Hospital, Jiangnan University Medical Center, JUMC. Wuxi, Jiangsu, 214000, China
| |
Collapse
|
4
|
Du H, Shen Y, Yang H, Chen J. A novel mini-open sublay hernioplasty combined with D10 mesh for primary lumbar hernia: a retrospective analysis of 48 cases. Hernia 2023; 27:1283-1288. [PMID: 37277523 DOI: 10.1007/s10029-023-02812-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/21/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND The aim of this study was to explore the safety and efficacy of a novel mini-open sublay hernioplasty with D10 mesh for primary lumbar hernias. METHODS This retrospective study included 48 patients with primary lumbar hernias who underwent mini-open sublay hernioplasty with D10 mesh from January 2015 to January 2022 in our hospital. Observation indicators were intraoperative measured diameter of hernia ring defect, operation time, length of hospital stay, postoperative follow-up, complications, postoperative visual analog scale (VAS) score, chronic pain. RESULTS The operations were completed successfully in all 48 cases. The mean diameter of hernia ring was 2.66 ± 0.57 cm (range 1.5-3.0 cm), the mean operation time was 41.54 ± 13.21 min (range 25-70 min), the intraoperative blood loss was 9.89 ± 6.16 ml (range 5-30 ml), and the mean hospital stay was 3.14 ± 1.53 days (range 1-6 days). The mean preoperative and postoperative VAS scores at 24 h were 0.29 ± 0.53 (range 0-2) and 2.52 ± 0.61 (range 2-6), respectively. All cases were followed-up for 53.4 ± 24.3 months (range 12-96 months) without seroma, hematoma, incision or mesh infection, recurrence, and obvious chronic pain. CONCLUSION A novel mini-open sublay hernioplasty with D10 mesh for primary lumbar hernias is safe and feasible. Its efficacy in the short term is favorable.
Collapse
Affiliation(s)
- H Du
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 5 Jingyuan Road, Shijingshan District, Beijing, 100043, China
| | - Y Shen
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 5 Jingyuan Road, Shijingshan District, Beijing, 100043, China.
| | - H Yang
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 5 Jingyuan Road, Shijingshan District, Beijing, 100043, China
| | - J Chen
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 5 Jingyuan Road, Shijingshan District, Beijing, 100043, China
| |
Collapse
|
5
|
Alves DG, Sousa J, Rodrigues C, Silva S, Ribeiro R. Primary Petit Hernia: From Diagnosis to Open Surgical Approach. Cureus 2023; 15:e35789. [PMID: 37025712 PMCID: PMC10072784 DOI: 10.7759/cureus.35789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2023] [Indexed: 03/07/2023] Open
Abstract
Lumbar hernias are quite rare, even more so when primary or of spontaneous nature. These defects in the lumbar region demand a comprehensive knowledge of the anatomy of the lateral abdominal wall and paraspinal muscles. Given the proximity of bone structures, they can pose a surgical challenge when trying to achieve an ideal dissection and appropriate mesh overlap. The authors report the case of a primary Petit's hernia that underwent an open anterior surgical approach with the use of a preperitoneal mesh. In addition to the described surgical technique, the article also aims to detail the diagnosis and anatomic classification of this rare pathology.
Collapse
|
6
|
Khetan M, Kalhan S, John S, Sethi D, Kannaujiya P, Ramana B. MIS retromuscular repair of lateral incisional hernia: technological deliberations and short-term outcome. Hernia 2022; 26:1325-1336. [DOI: 10.1007/s10029-022-02671-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 08/30/2022] [Indexed: 11/29/2022]
|
7
|
Cassese G, Castaldi A, Al Taweel B, Le Quintrec M, Thuret R, Navarro F, Panaro F. Incisional hernia repair after kidney transplantation in a tertiary high-volume center: outcomes from a 10-year retrospective cohort study. Int Urol Nephrol 2022; 54:525-531. [PMID: 35112319 DOI: 10.1007/s11255-021-03101-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 12/26/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND AIM Incisional hernia (IH) after Kidney Transplantation (KT) is a challenging complication due to both technical reasons and patients' complexity. Data regarding outcomes of hernia repair in KT recipients are uncertain, since the biggest part of previous papers focused on risk factors for incisional hernia occurrence and not on its outcomes. Aim of the study was to focus on risk factors for incisional hernia recurrence after surgical repair in KT recipients. METHODS Data regarding all consecutive patients undergoing kidney transplantations from January 2011 until September 2020 in Montpellier University Hospital were retrospectively collected from a single institutional database. RESULTS After a median follow-up of 48 months (IQR25-75 31-59), data from 1546 consecutive KT were collected. 83 patients underwent 99 incisional hernia surgeries after KT, with 14 patients that had one recurrence (14.4%) and 2 patients that experienced two recurrences (2.4%). Total recurrence rate was 16.8%. At univariate analysis, the only factor associated with an incisional hernia recurrence was having undergone to at least one previous abdominal surgery other than KT (p value 0.002). Overall morbidity was 15% (n = 15), with most of complications classified as mild (59%). No mortality related to incisional hernia repair occurred. CONCLUSION IHs after KT represent an important condition. Its surgical management is challenging due to its anatomical complexity and patient's status. This is the largest sample size in the literature of patients treated for IH after KT and it shows that a previous surgery other than the KT is a risk factor for hernia recurrence after surgical repair, without regarding surgical technique or other comorbidity and therapeutical factors.
Collapse
Affiliation(s)
- Gianluca Cassese
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Antonio Castaldi
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy.,Department of HPB Surgery and Liver Transplantation, Montpellier University Hospital-School of Medicine, 34000, Montpellier, France
| | - Bader Al Taweel
- Department of HPB Surgery and Liver Transplantation, Montpellier University Hospital-School of Medicine, 34000, Montpellier, France
| | - Moglie Le Quintrec
- Department of Nephrology and Kidney Transplantation, Montpellier University Hospital, Montpellier, France
| | - Rodolphe Thuret
- Department of Urology and Kidney Transplantation, Montpellier University Hospital, Montpellier, France
| | - Francis Navarro
- Department of HPB Surgery and Liver Transplantation, Montpellier University Hospital-School of Medicine, 34000, Montpellier, France
| | - Fabrizio Panaro
- Department of HPB Surgery and Liver Transplantation, Montpellier University Hospital-School of Medicine, 34000, Montpellier, France.
| |
Collapse
|
8
|
Tanwar M, Dagar A, Hurria N, Chandrakar S, Gupta S, Sinha A. The lumbar hernia: A clinical conundrum. FORMOSAN JOURNAL OF SURGERY 2022. [DOI: 10.4103/fjs.fjs_91_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
9
|
Li J. The role of ultrasound in the diagnosis of Grynfeltt-Lesshaft lumbar hernia: A case report. Australas J Ultrasound Med 2021; 24:178-180. [PMID: 34765428 DOI: 10.1002/ajum.12276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 05/15/2021] [Accepted: 05/30/2021] [Indexed: 11/10/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Jenny Li
- Department of Ultrasound Mercy Radiology Auckland New Zealand
| |
Collapse
|
10
|
Shen C, Zhang G, Zhang S, Yin Y, Zhang B, Song Y, Lei W. Clinical, surgical characteristics and long-term outcomes of lumbar hernia. BMC Surg 2021; 21:332. [PMID: 34445979 PMCID: PMC8394050 DOI: 10.1186/s12893-021-01328-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 08/16/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND/AIM Lumbar hernia is caused by a defect in the abdominal wall. Due to its rarity, there is no established consensus on optimal treatment for lumbar hernia yet. Thus, we here investigated the clinical, surgical characteristics and outcomes of lumbar hernia by collecting 28 such patients from our hospital. METHODS Patients diagnosed with lumbar hernia from our institution between April 2011 and August 2020 were retrospectively collected in this study. Demographics, clinical characteristics and surgical information were recorded. RESULTS A consecutive series of 28 patients with lumbar hernia were retrospectively collected, including 13 males (46%) and 15 females (54%). The ages of the patients ranged from 5 to 79 years (median: 55 years), with a mean age of 55.6 ± 14.9 years. A total of 7 cases had a history of previous lumbar trauma or surgery. There were 11 (39%), 15 (54%) and 2 (7.1%) cases had right, left and bilateral lumbar hernia, respectively. Superior and inferior lumbar hernia were found in 25 (89%) and 3 (11%) patients. General anesthesia was adopted in 16 cases (group A), whereas 12 patients received local anesthesia (group B). Patients in the group B had a shorter hospital stay than that of the group A (3.5 ± 1.3 days vs. 7.1 ± 3.2 days, p = 0.001), as well as total hospitalization expenses between the two groups (2989 ± 1269 dollars vs. 1299 ± 229 dollars, p < 0.001). With a median follow-up duration of 45.9 months (range: 1-113 months), only 1 (3%) lumbar hernias recurred for the entire cohort. CONCLUSIONS Lumbar hernia is a relatively rare entity, and inferior lumbar hernia is rarer. It is feasible to repair lumbar hernia under local anesthesia.
Collapse
Affiliation(s)
- Chaoyong Shen
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Guixiang Zhang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Sen Zhang
- Department of Gastrointestinal Surgery, Chengdu Second People's Hospital, Chengdu, 610041, Sichuan, China
| | - Yuan Yin
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Bo Zhang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
| | - Yinghan Song
- Department of Day Surgery Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
| | - Wenzhang Lei
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
| |
Collapse
|
11
|
Abstract
PURPOSE Congenital lumbar hernia is defined as the protrusion of intraperitoneal or extraperitoneal viscera through a defect of the posterior abdominal wall, present at birth. The aim of our study was to perform a systematic review of this rare pathology, with emphasis on surgical decision-making. METHODS The English literature (2000-2020) was reviewed, using PubMed, EMBASE and GoogleScholar databases, combining the terms "hernia", "lumbar", "flank", "Grynfeltt", "Petit" and "congenital". Overall, 35 studies were included, describing 85 patients. RESULTS Mean age was 9.7 ± 20.7 months (range 1 day-10 years). 55.7% were males and 44.3% were females. All patients presented electively, with flank bulging as the main symptom. Superior lumbar triangle (Grynfeltt) herniae accounted for 41.8%, inferior lumbar triangle (Petit) herniae for 32.8%, whereas 25.4% were classified as diffuse. A left-sided hernia was observed in 47%, a right-sided in 42.4%, while 10.6% were bilateral. 71.8% of the patients had associated anatomical anomalies, mainly the lumbocostovertebral syndrome. Most patients (83.3%) were treated surgically, while 16.7% conservatively with surveillance. In 93.3%, the surgical approach was open, with laparoscopy employed in 6.7% of cases. The majority (71.7%) underwent primary suture repair of the hernia defect, whereas a mesh was required in 28.3%. Post-operative morbidity was 6.7% and recurrence rate was 3.3% at a mean follow-up of 26.4 months. CONCLUSION Congenital lumbar hernia is a rare pathology in the paediatric population, with only 85 cases reported since 2000. Although the diagnosis is frequently straightforward, it should raise the suspicion for associated congenital anomalies and further investigation is required, with cross-sectional imaging. Surgical repair is usually performed during the first year, to allow for symmetrical torso development.
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
Katkhouda N, Alicuben ET, Pham V, Sandhu K, Samakar K, Bildzukewicz N, Houghton C, Dunn CP, Hawley L, Lipham J. Management of lateral abdominal hernias. Hernia 2020; 24:353-358. [PMID: 32052297 DOI: 10.1007/s10029-020-02126-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 01/08/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE Lateral abdominal wall hernias are rare defects but, due to their location, repair is difficult, and recurrence is common. Few studies exist to support a standard protocol for repair of these lateral hernias. We hypothesized that anchoring our repair to fixed bony structures would reduce recurrence rates. METHODS A retrospective review of all patients who underwent lateral hernia repair at our institution was performed. RESULTS Eight cases (seven flank and one thoracoabdominal) were reviewed. The median defect size was 105 cm2 (range 36-625 cm2). The median operative time was 185 min (range 133-282 min). There were no major complications. One patient who was repaired without mesh attachment to bony landmarks developed a recurrence at ten months and subsequently underwent reoperation. Patients with mesh secured to bony landmarks were recurrence free at a median follow-up of 171 days. CONCLUSIONS Lateral hernias present a greater challenge due to their anatomic location. An open technique with mesh fixation to bony structures is a promising solution to this complex problem.
Collapse
Affiliation(s)
- N Katkhouda
- Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of University of Southern California, 1510 San Pablo Street, HCC I, Suite 527, Los Angeles, CA, 90033-4612, USA.
| | - E T Alicuben
- Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of University of Southern California, 1510 San Pablo Street, HCC I, Suite 527, Los Angeles, CA, 90033-4612, USA
| | - V Pham
- Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of University of Southern California, 1510 San Pablo Street, HCC I, Suite 527, Los Angeles, CA, 90033-4612, USA
| | - K Sandhu
- Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of University of Southern California, 1510 San Pablo Street, HCC I, Suite 527, Los Angeles, CA, 90033-4612, USA
| | - K Samakar
- Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of University of Southern California, 1510 San Pablo Street, HCC I, Suite 527, Los Angeles, CA, 90033-4612, USA
| | - N Bildzukewicz
- Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of University of Southern California, 1510 San Pablo Street, HCC I, Suite 527, Los Angeles, CA, 90033-4612, USA
| | - C Houghton
- Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of University of Southern California, 1510 San Pablo Street, HCC I, Suite 527, Los Angeles, CA, 90033-4612, USA
| | - C P Dunn
- Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of University of Southern California, 1510 San Pablo Street, HCC I, Suite 527, Los Angeles, CA, 90033-4612, USA
| | - L Hawley
- Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of University of Southern California, 1510 San Pablo Street, HCC I, Suite 527, Los Angeles, CA, 90033-4612, USA
| | - J Lipham
- Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of University of Southern California, 1510 San Pablo Street, HCC I, Suite 527, Los Angeles, CA, 90033-4612, USA
| |
Collapse
|
14
|
Lee JH, Steen C. Case study of the lumbar hernia: the rare diagnosis often missed. ANZ J Surg 2019; 90:E75-E76. [PMID: 31083819 DOI: 10.1111/ans.15303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 04/22/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Jia Hui Lee
- Department of General Surgery, Eastern Health Victoria, Melbourne, Victoria, Australia
| | - Christopher Steen
- Department of General Surgery, Eastern Health Victoria, Melbourne, Victoria, Australia
| |
Collapse
|
15
|
Pang RR, Makowski AL. Inferior lumbar triangle hernia with incarceration. Am J Emerg Med 2019; 37:1218.e5-1218.e6. [PMID: 31027934 DOI: 10.1016/j.ajem.2019.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 04/09/2019] [Indexed: 11/29/2022] Open
Abstract
Lumbar hernia is a rare condition in which intra or extraperitoneal tissue protrudes through a defect in the posterolateral region of the flank. Incarceration is uncommon but represents a surgical emergency when present. A 54-year-old-male presented to the ED after sudden onset left flank pain after coughing. He was in significant distress secondary to pain and vomiting, and his physical exam revealed a tender mass in his left lateral lumbar region near the site of a previous stab wound. Bedside ultrasound revealed a fluid-filled structure, and CT scan demonstrated herniation of small bowel though the inferior lumbar triangle with associated small bowel obstruction. The patient underwent emergent surgical reduction with mesh repair and recovered uneventfully. Incarcerated lumbar hernia represents a rare diagnosis that may not be at the forefront of most practitioners' differential diagnoses. CT scan is useful to distinguish hernia from solid mass, abscess, or other pathology, while bedside ultrasound may prompt an attempt at immediate reduction. The presence of incarcerated bowel or obstruction warrants immediate surgical consultation.
Collapse
Affiliation(s)
- Ran R Pang
- Transitional Year Residency, Ascension St. Joseph's Hospital, Department of Emergency Medicine, 5000 W. Chambers St., Milwaukee, WI 53210, United States of America
| | - Andrew L Makowski
- Emergency Department Attending, Ascension St. Joseph's Hospital, Department of Emergency Medicine, 5000 W. Chambers St., Milwaukee, WI 53210, United States of America.
| |
Collapse
|
16
|
Kadler B, Shetye A, Patten DK, Al-Nowfal A. A primary inferior lumbar hernia misdiagnosed as a lipoma. Ann R Coll Surg Engl 2019; 101:e96-e98. [PMID: 30773901 DOI: 10.1308/rcsann.2019.0009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Lumbar hernias can be superior (Grynfelt) and inferior (Petit). Inferior lumbar hernias are extremely rare and, therefore, are associated with diagnostic difficulty. We present a case of a primary spontaneous inferior lumbar hernia in a 79-year-old woman that was initially diagnosed as a large lipoma on ultrasound. The first operation was abandoned and an open mesh repair was conducted. Lumbar hernias can be primary acquired (55%), secondary acquired (25%) or congenital (20%). Cross-sectional imaging by CT or MRI appears to be the gold standard in diagnosis as ultrasound may lead to misdiagnosis. Strangulation, incarceration and obstruction are recognised complications, requiring prompt surgical intervention. There are currently no guidelines for surgical managements, although laparoscopic surgery may give the best results. In view of the scarcity of published cases, we aim to add to the literature to raise the index of suspicion and to promote prompt surgical management of lumbar hernias.
Collapse
Affiliation(s)
- B Kadler
- Academic Hepatology, Barts Health NHS Trust, Whitechapel , London , UK
| | - A Shetye
- General Surgery, Homerton University Hospital NHS Foundation Trust , London , UK
| | - D K Patten
- General Surgery, Homerton University Hospital NHS Foundation Trust , London , UK.,Department of Surgery and Cancer, Imperial College London, Imperial Centre for Translational and Experimental Medicine, Hammersmith Campus , Du Cane Road, London, W12 0NN
| | - A Al-Nowfal
- General Surgery, Homerton University Hospital NHS Foundation Trust , London , UK
| |
Collapse
|
17
|
|
18
|
Tchoungui Ritz FJ, Kouam V, Titcheu F. Primary Jean Louis Petit and Grynfeltt-Lesshaft concomitant hernias: A case report. Int J Surg Case Rep 2018; 51:1-4. [PMID: 30121395 PMCID: PMC6098233 DOI: 10.1016/j.ijscr.2018.07.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 07/06/2018] [Accepted: 07/30/2018] [Indexed: 11/20/2022] Open
Abstract
Primary lumbar hernia. Concomitant lumbar hernias : Jean Louis Petit and Grynfeltt-Lesshaft. Misdiagnosis hernia. 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.
Collapse
Affiliation(s)
- Frederica Jessie Tchoungui Ritz
- Surgical Department of Saint John of Malt Hospital, PO Box: 56, Njombe, Cameroon; Faculty of Medicine, Pharmacy and Odontology, Cheikh Anta Diop University, PO Box: 5005, Dakar, Senegal.
| | - Vanessa Kouam
- Faculty of Medicine and Pharmaceutical Sciences, The University of Douala, PO Box: 2701, Douala, Cameroon.
| | - Flobert Titcheu
- Surgical Department of Saint John of Malt Hospital, PO Box: 56, Njombe, Cameroon.
| |
Collapse
|
19
|
Abstract
Due to the rarity of Grynfelt hernia, there is no standardized surgical technique.From April 2010 to September 2017, 12 cases of primary superior lumbar hernia (Grynfelt hernia) were identified through medical records reviewing and included in our study. Perioperative data, surgical outcomes, and long-term follow-up results were retrospectively analysed.Male/female ratio of patients was 1:1, with age 69.5 (62, 74.5) [median (25 percentile, 75 percentile)] years old. Right/left side ratio of lumbar hernia was 9/3. The in-hospital duration was 7 (5, 8) days. The surgical duration was 35 (30, 50) minutes. The defect size was 2.1 (1.5, 3) cm in diameter. The discharge of the patient was on 3 (2, 4) post-operative day (POD). The meshes used were: MK5816 (10), MK5810 (1), and UHS (1). There was only 1 case of postoperative complication where the patient was admitted in intensive care unit (ICU) due to hypoxemia. Morbidity, mortality, and recurrence cases were null.Our study indicates that open surgery with mesh implantation is a reliable way for the management of primary superior lumbar hernia.
Collapse
|
20
|
Schwab R, Sahm J, Willms AG. Video-Assisted Mini-Open Sublay (VAMOS): A Simple Hybrid Approach for Lateral Incisional Hernias. Front Surg 2018; 5:29. [PMID: 29670883 PMCID: PMC5893812 DOI: 10.3389/fsurg.2018.00029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 03/21/2018] [Indexed: 11/16/2022] Open
Abstract
Purpose The purpose is to present a new hybrid approach of lateral incisional hernia repair associated with reduced operative trauma and anatomically optimal mesh placement. Methods Video-Assisted Mini-Open Sublay (VAMOS) consists of a laparoscopic atraumatic dissection of the hernia sac, diaphanoscopy, laparoscopically-assisted closure of the fascial gap and mesh placement in sublay position through a minimized skin incision. Feasibility of this concept was assessed in a cohort of 7 consecutive patients. Results VAMOS approach was feasible in all 7 patients. Median hernia size was 8 cm, the median skin incision width was 7.7 cm. Median operative time was 86 min. In all patients a sufficient mesh overlap on all sides of the fascial gap was ensured. On short-term follow-up no procedure related complications were recorded, seroma formation occurred in 2 patients. Pain medication was necessary for median 4.9 days. There was no need for pain medication on day 14, whatsoever. Conclusion Initial VAMOS results show that the technique is simple, time-saving and safe. It provides a substantial reduction in postoperative pain compared to an open approach. Through implantation in the intermuscular sublay position and minor access-related trauma, it is possible to achieve a biomechanically optimal mesh position, to lay the foundations for adequate remodelling of the abdominal wall, and to prevent recurrence as well as local complications. All in all, VAMOS appears to have several advantages over current surgical strategies.
Collapse
Affiliation(s)
- Robert Schwab
- Department of General, Visceral and Thoracic Surgery, German Armed Forces Central Hospital, Koblenz, Germany
| | - Joachim Sahm
- Department of General, Visceral and Thoracic Surgery, German Armed Forces Central Hospital, Koblenz, Germany
| | - Arnulf Gregor Willms
- Department of General, Visceral and Thoracic Surgery, German Armed Forces Central Hospital, Koblenz, Germany
| |
Collapse
|
21
|
Abstract
Flank and lumbar hernias are challenging because of their rarity and anatomic location. Several challenges exist when approaching these specific abdominal wall defects, including location, innervation of the lateral abdominal wall musculature, and their proximity to bony landmarks. These hernias are confined by the costal margin, spine, and pelvic brim, which makes closure of the defect, including mesh placement, difficult. This article discusses the anatomy of lumbar and flank hernias, the various etiologies for these hernias, and the procedural steps for open and robotic preperitoneal approaches. The available clinical evidence regarding outcomes for various repair techniques is also reviewed.
Collapse
Affiliation(s)
- Lucas R Beffa
- Division of Minimal Access and Bariatric Surgery, Greenville Health System, University of South Carolina School of Medicine - Greenville, Greenville, SC, USA
| | - Alyssa L Margiotta
- Division of Minimal Access and Bariatric Surgery, Greenville Health System, University of South Carolina School of Medicine - Greenville, Greenville, SC, USA
| | - Alfredo M Carbonell
- Division of Minimal Access and Bariatric Surgery, Greenville Health System, University of South Carolina School of Medicine - Greenville, Greenville, SC, USA.
| |
Collapse
|
22
|
Novitsky YW. Laparoscopic repair of traumatic flank hernias. Hernia 2017; 22:363-369. [PMID: 29247364 DOI: 10.1007/s10029-017-1707-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 12/01/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Traumatic flank hernias (TFH) are caused by a blunt abdominal trauma with resultant detachment of the oblique musculofascial complex at the iliac crest and/or costal margin. Given such proximity to the bony structures and essential absence of healthy fascia to anchor the mesh, TFH represent a challenging surgical problem. Although laparoscopic repair of ventral hernias has become very common, no series of laparoscopic repairs of TFH has been reported to date. We present a series of patients undergoing laparoscopic repair of TFH. METHODS After retrospective review of prospective hernia database at two Hernia centers, patients undergoing laparoscopic TFH repair were identified and analyzed. Main outcome measures included patient demographics, surgical technique, intraoperative data, and post-operative outcomes. RESULTS From December 2007 to December 2013, 14 patients underwent laparoscopic repair of a TFH. Eleven patients had chronically incarcerated viscera within the defect. Operative steps included complete reduction of the hernia sac, pre/retroperitoneal dissection to expose the entire lateral edge of a psoas muscle, defect closure with transabdominal sutures, wide mesh overlap, and transabdominal suture fixation with selective use of bone anchors. The mean operative time was 174 min (range 125-230). Mean estimated blood loss was 65 cc. Mean mesh size was 295 cm2. There were no peri-operative complications. Mean hospital stay was 3.1 days and all patients returned to full activities by 6 weeks. At a mean follow-up of 35 months, there have been no recurrences. CONCLUSION Laparoscopic approach to TFH is feasible and safe. It is associated with minimal hospital stay and fast functional recovery. The key components of our approach include wide pre/retroperitoneal with defect closure and subsequent wide mesh underlay coverage with fixation to bony structures using anchors/screws. We believe that the laparoscopic approach should safely considered for the majority of patients with TFH.
Collapse
Affiliation(s)
- Y W Novitsky
- Department of Surgery, University of Connecticut Medical Center, Farmington, CT, USA. .,Department of Surgery, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA.
| |
Collapse
|
23
|
Stupalkowska W, Powell-Brett SF, Krijgsman B. Grynfeltt-Lesshaft lumbar hernia: a rare cause of bowel obstruction misdiagnosed as a lipoma. J Surg Case Rep 2017; 2017:rjx173. [PMID: 28928928 PMCID: PMC5597899 DOI: 10.1093/jscr/rjx173] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 07/10/2017] [Accepted: 08/11/2017] [Indexed: 12/30/2022] Open
Abstract
Grynfeltt-Leschaft hernia is a type of lumbar hernia occurring in the superior lumbar triangle. Because of its rarity and non-specific presentation, lumbar hernia often poses a diagnostic challenge, and it can be easily misdiagnosed as a lipoma. If the correct diagnosis is missed, there is a significant risk of complications including hernia incarceration or strangulation. Here, we present a case of Grynfeltt-Lesshaft hernia which was repeatedly misdiagnosed as a lipoma and presented acutely with large bowel obstruction. A definite diagnosis was made by a computed tomography scan and the patient had emergency laparotomy and successful mesh repair of the hernia defect.
Collapse
Affiliation(s)
| | | | - Brandon Krijgsman
- Department of General Surgery, Peterborough City Hospital, Peterborough, UK
| |
Collapse
|
24
|
Pristavu AI, Furnica C, Ifrim MM, Popovici RM. Early prenatal diagnosis of a lumbo-costo-vertebral syndrome. J Med Ultrason (2001) 2017; 45:353-355. [PMID: 28905199 DOI: 10.1007/s10396-017-0827-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Accepted: 08/07/2017] [Indexed: 11/25/2022]
Abstract
Lumbo-costo-vertebral syndrome (LCVS) is a rare type of lumbar hernia with associated abnormalities of the vertebral bodies, ribs, and trunk muscles. Only a few cases have been reported in the literature, all of which were diagnosed after birth. We present a case of LCVS diagnosed early in the second trimester of pregnancy using two- and three-dimensional ultrasound. In our case, the associated anomalies were: multiple costovertebral anomalies, lumbar hernia, anal imperforation, left hand supernumerary digit, and clubfoot.
Collapse
Affiliation(s)
- Anda Ioana Pristavu
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy "Grigore T. Popa", Str. Universitatii 16, 700115, Iasi, Romania.
| | - Cristina Furnica
- Institute of Legal Medicine, Iasi, Romania.,Department of Anatomy, University of Medicine and Pharmacy "Grigore T. Popa", Iasi, Romania
| | | | - Razvan Mihai Popovici
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy "Grigore T. Popa", Str. Universitatii 16, 700115, Iasi, Romania.,"Cuza Voda" Hospital, Iasi, Romania
| |
Collapse
|
25
|
Suh Y, Gandhi J, Zaidi S, Smith NL, Tan MY, Khan SA. Lumbar hernia: A commonly misevaluated condition of the bilateral costoiliac spaces. TRANSLATIONAL RESEARCH IN ANATOMY 2017. [DOI: 10.1016/j.tria.2017.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
|
26
|
Tieman JT, Robertson G. Novel Repair of Grynfeltt Hernia Using Self-Fixating Mesh. Am Surg 2017. [DOI: 10.1177/000313481708300301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Joshua T. Tieman
- Department of General Surgery University of Arizona Tucson, Arizona
| | | |
Collapse
|
27
|
Renard Y, de Mestier L, Cagniet A, Demichel N, Marchand C, Meffert JL, Kianmanesh R, Palot JP. Open retromuscular large mesh reconstruction of lumbar incisional hernias including the atrophic muscular area. Hernia 2017; 21:341-349. [DOI: 10.1007/s10029-016-1570-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 12/26/2016] [Indexed: 12/23/2022]
|
28
|
Cheung M, Chu FS, Kwan LP. Serial changes of computed tomographic peritoneogram in patients with symptomatic ultrafiltration failure complicating continuous ambulatory peritoneal dialysis. J Med Imaging Radiat Oncol 2016; 61:321-326. [PMID: 28004509 DOI: 10.1111/1754-9485.12564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 10/22/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION It is well-known that continuous ambulatory peritoneal dialysis (CAPD) is associated with complications. And some of these complications are well-demonstrated as abnormalities on computed tomographic peritoneogram (CTP). The objective of our study is to document the serial changes of these complications. METHODS We retrospectively reviewed 125 patients treated with CAPD for end staged renal failure (ESRF) who had CTP conducted in our hospital between December 2006 and August 2015. A total of 164 (n = 164) CTPs were performed. Patients with only one CTP performed were excluded from our study. A retrospective review of 68 serial CTPs studies on 28 patients during the 9-year period was undertaken. We looked into the serial changes on CTP. RESULTS Among the 28 patients who had serial imaging, 46.43% of patients were found to have retroperitoneal leakage; 92.31% of them showed resolution in subsequent serial CTP. 21.43% of patients had anterior abdominal wall leakage; none of them resolved in subsequent CTP. 14.29% of patients were found to have inguinal hernias; 75% of them showed interval progression in subsequent serial CTPs. CONCLUSION Retroperitoneal leakage is a common complication in patients on CAPD and tends to resolve whereas other complications including anterior abdominal wall leakage and hernias are unlikely to resolve and may progress further.
Collapse
Affiliation(s)
- Michelle Cheung
- Department of Radiology, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Ferdinand Sk Chu
- Department of Radiology, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Lorraine Py Kwan
- Department of Medicine, Queen Mary Hospital, Pokfulam, Hong Kong
| |
Collapse
|
29
|
Congenital Lumbar Hernia: A 15-Year Experience at a Single Tertiary Centre. Int J Pediatr 2016; 2016:7162475. [PMID: 27994626 PMCID: PMC5138478 DOI: 10.1155/2016/7162475] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 11/02/2016] [Indexed: 12/13/2022] Open
Abstract
Aim. Congenital lumbar hernia is an uncommon anomaly with only few cases reported in the English literature. This study was done to study the incidence, age at presentation, sex, associated anomalies, surgical management, and postoperative morbidity and mortality of congenital lumbar hernia in pediatric patients. Methods. Retrospective analysis of all patients of CLH over a period of 15 years (January 2000 to December 2015) was analyzed. Results. A total of 14 patients were encountered in this series. All presented within first 2 years of age. 12 were males and 2 were females. All of them presented with swelling in lumbar region. 13 were unilateral and 1 was bilateral. Left sided hernia was observed in 2 cases only. Lumbocostovertebral syndrome was found in all the patients in addition to other rare anomalies. All cases were managed with open surgical repair. Wound infection was seen in 2 cases. There was no mortality in our series. Conclusion. CLH is very rare among hernias. Surgery should be carried out within 1 year of age. For a defect of <5 cm, primary repair is done. For a defect of >5 cm, meshplasty should be considered. Prognosis is excellent.
Collapse
|
30
|
Upper Calyx Approachability through a Lower Calyx Access for Prone Versus Supine Percutaneous Nephrolithotomy. J Urol 2016; 195:377-82. [DOI: 10.1016/j.juro.2015.07.101] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2015] [Indexed: 11/23/2022]
|
31
|
Abstract
This report describes an alternative technique for Petit hernia repair. The treatment of lumbar hernias should follow the concept of tension-free surgery, and the preperitoneal space can be the best place for prosthesis placement. An obese patient had a bulge in the right lumbar region, which gradually grew and became symptomatic, limiting her daily activities and jeopardizing her quality of life. She had previously undergone 2 surgical procedures with different incisions. We created a preperitoneal space and attached a mesh in this position. Another prosthesis was placed on the muscles, with a suitable edge beyond the limits of the defect. There were no complications. It has been described as a safe and tension-free repair for Petit hernia. In larger defects, a second mesh can be used to prevent further enlargement of the triangle and also to provide additional protection beyond the bone limits.
Collapse
|
32
|
Pulikkottil BJ, Pezeshk RA, Daniali LN, Bailey SH, Mapula S, Hoxworth RE. Lateral Abdominal Wall Defects: The Importance of Anatomy and Technique for a Successful Repair. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2015; 3:e481. [PMID: 26495194 PMCID: PMC4560214 DOI: 10.1097/gox.0000000000000439] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 06/03/2015] [Indexed: 11/25/2022]
Abstract
Flank and lateral abdominal wall defects can be an extremely challenging phenomenon for surgeons to undertake. Their rarity and specific idiosyncrasies in regard to embryologic and anatomical characteristics must be taken into consideration when formulating an operative plan. We will discuss these cardinal points including technical recommendations by notable experts in the field to gain a better understanding in the diagnosis and treatment of this infrequent but morbid occurrence.
Collapse
Affiliation(s)
- Benson J Pulikkottil
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Tex
| | - Ronnie A Pezeshk
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Tex
| | - Lily N Daniali
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Tex
| | - Steven H Bailey
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Tex
| | - Steven Mapula
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Tex
| | - Ronald E Hoxworth
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Tex
| |
Collapse
|
33
|
Petro CC, Orenstein SB, Criss CN, Sanchez EQ, Rosen MJ, Woodside KJ, Novitsky YW. Transversus abdominis muscle release for repair of complex incisional hernias in kidney transplant recipients. Am J Surg 2015; 210:334-9. [DOI: 10.1016/j.amjsurg.2014.08.043] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Revised: 08/24/2014] [Accepted: 08/28/2014] [Indexed: 10/24/2022]
|
34
|
Laparoscopic repair for a congenital lumbar hernia with free fascia lata graft reinforcement. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2014. [DOI: 10.1016/j.epsc.2014.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
35
|
Abstract
This article reviews the incidence, presentation, anatomy, and surgical management of abdominal wall defects found in the pediatric population. Defects such as inguinal hernia and umbilical hernia are common and are encountered frequently by the pediatric surgeon. Recently developed techniques for repairing these hernias are aimed at improving cosmesis and decreasing pain while maintaining acceptably low recurrence rates. Less common conditions such as femoral hernia, Spigelian hernia, epigastric hernia, lumbar hernia, gastroschisis, and omphalocele are also discussed. The surgical treatment of gastroschisis and omphalocele has undergone some advancement with the use of various silos and meshes.
Collapse
|
36
|
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]
|
37
|
Petersen K, Snikeris J, Hall TS. Bleichner's hernia - lumbar hernia. AMERICAN JOURNAL OF CASE REPORTS 2013; 14:26-9. [PMID: 23569557 PMCID: PMC3614380 DOI: 10.12659/ajcr.883760] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Accepted: 05/10/2012] [Indexed: 02/04/2023]
Abstract
BACKGROUND We present a case of a lumbar hernia and a review of the literature of this rare hernia type. CASE REPORT The case and the review will discuss the unusual presentations reported, common etiologies, the importance of early operative repair based on the high rate of incarceration and the recent recommendations regarding repair techniques. CONCLUSIONS Lumbar hernias are rare cases, but should be pursued in diagnosis and treated aggressively because of the high rate of incarceration. Repair can be accomplished with a minimally invasive technique.
Collapse
Affiliation(s)
- Katherine Petersen
- Department of Surgery, The Stamford Hospital, Columbia University, CT, U.S.A
| | - Jaclyn Snikeris
- Department of Surgery, The Stamford Hospital, Columbia University, CT, U.S.A
| | - Timothy S. Hall
- Department of Surgery, The Stamford Hospital, Columbia University, CT, U.S.A
| |
Collapse
|
38
|
Vagholkar K, Dastoor K. Congenital lumbar hernia with lumbocostovertebral syndrome: a case report and review of the literature. Case Rep Pediatr 2013; 2013:532910. [PMID: 24159401 PMCID: PMC3789277 DOI: 10.1155/2013/532910] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 08/23/2013] [Indexed: 02/07/2023] Open
Abstract
Introduction. Congenital lumbar hernia is one of the rare types of hernias. Anomalies of the ribs, spine, and muscles which constitute the lumbocostovertebral syndrome in association with congenital lumbar hernia make it the rarest of entities. In addition, a multitude of other organ systems may be involved. Case Report. A case of congenital lumbar hernia associated with lumbocostovertebral syndrome is presented in view of its rarity and diagnostic and therapeutic challenges. Discussion. Anatomical background of congenital lumbar hernia associated with various other anomalies especially of the musculoskeletal structures is discussed. All cases of congenital lumbar hernia should be investigated for other congenital anomalies. Both open and laparoscopic approaches have been described for surgical treatment. Conclusion. Open surgical intervention is the mainstay of treatment taking into consideration the technical challenges posed by distorted anatomy due to the associated congenital anomalies.
Collapse
Affiliation(s)
- Ketan Vagholkar
- 1Department of Surgery, Dr. D. Y. Patil Medical College, Navi Mumbai, Maharashtra 400706, India
- 2Annapurna Niwas, 229 Ghantali Road, Thane 400602, India
- *Ketan Vagholkar:
| | - Khojasteh Dastoor
- 1Department of Surgery, Dr. D. Y. Patil Medical College, Navi Mumbai, Maharashtra 400706, India
| |
Collapse
|
39
|
Olin SJ, Holmes SP, Jeffs A, Cornell KK. Bilateral lumbar hernias in a domestic shorthair cat. J Am Vet Med Assoc 2012; 241:1495-8. [PMID: 23176243 DOI: 10.2460/javma.241.11.1495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CASE DESCRIPTION A 2.8-kg (6.1-lb) 4-month-old sexually intact female domestic shorthair cat was referred for evaluation of bilateral, subcutaneous lumbar masses that were presumed to be the kidneys. CLINICAL FINDINGS Physical examination findings included 2 mobile, nonpainful, 3×3-cm, bilaterally symmetric masses in the dorsolateral lumbar region. Abdominal radiography, ultrasonography, and CT confirmed bilateral body wall defects with renal herniation. Serum biochemistry profile, urinalysis, and excretory urography confirmed normal renal function. TREATMENT AND OUTCOME Exploratory laparotomy, reduction of the kidneys, repair of the body wall defects, bilateral nephropexy, and ovariohysterectomy were performed. There were no perioperative complications. CLINICAL RELEVANCE Lumbar hernia has not been reported previously in a cat. It is important for veterinarians to be aware that although rare, lumbar hernia should be included in the list of differential diagnoses for a lumbar mass or signs of chronic lumbar pain in cats.
Collapse
Affiliation(s)
- Shelly J Olin
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA 30605, USA
| | | | | | | |
Collapse
|
40
|
Sharma A, Pandey A, Rawat J, Ahmed I, Wakhlu A, Kureel SN. Congenital lumbar hernia: 20 years' single centre experience. J Paediatr Child Health 2012; 48:1001-3. [PMID: 23039934 DOI: 10.1111/j.1440-1754.2012.02581.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
AIM Congenital lumbar hernia is an uncommon anomaly with only few cases reported in the English literature. This study was done to study the incidence, associated conditions, management and complications of congenital lumbar hernia repair in paediatric patients. METHODS Retrospective study of all patients over a period of 20 years (January 1990 to January 2010) was analysed. RESULTS A total of 18 patients (two bilateral hernias) were encountered in this series. All were in the age group of 1 day to 6 years. All the patients were operated by open technique. Primary repair was done in 14 patients and prosthetic meshplasty in two. Two patients could not be operated. The average follow-up period was 3 years. There was no follow-up loss in our study. There was no evidence of recurrence in this series. CONCLUSION Up until now, the total number of cases is 68. The large size of hernia defect (>10 cm) may determine the use of prosthetic mesh repair. Proper surgical treatment, either primary repair or hernioplasty, provides adequate management of this condition.
Collapse
Affiliation(s)
- Anshuman Sharma
- Department of Pediatric Surgery, King George's Medical University, Lucknow, India
| | | | | | | | | | | |
Collapse
|
41
|
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.
Collapse
|
42
|
Retromuscular preperitoneal repair of flank hernias. J Gastrointest Surg 2012; 16:1548-53. [PMID: 22528575 DOI: 10.1007/s11605-012-1890-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Accepted: 04/10/2012] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Flank hernias represent a challenging problem to reconstructive surgeons. Their anatomic proximity to the bony prominence and major neurovascular structures limits fixation options and restricts mesh overlap. We present our technique and outcomes of a preperitoneal repair with wide mesh overlap. METHODS This study is a retrospective analysis of patients undergoing open flank hernia repair with a retromuscular preperitoneal approach. RESULTS Between September 2007 and April 2011, 16 patients, mean age 55 years (range 34-80) and BMI 33 kg/m² (range 26-46), underwent open flank hernia repair. Eight were recurrent hernias; six previously had mesh placed; nine were incarcerated. Mean hernia defect size was 232 cm² (range 25-800). Mean operative time was 178 min (range 105-245). One intraoperative complication, ureteral injury in a transplant recipient, occurred and was primarily repaired without sequela. Two patients developed wound complications, one requiring superficial debridement and another requiring partial excision (<5 %) of the mesh with secondary healing. With a mean follow-up of 16.8 months (range 2-49), no recurrent hernias were noted. CONCLUSION Open retromuscular preperitoneal repair of flank hernias with iliac bone fixation is technically feasible, allowing wide mesh overlap for a durable repair. This approach may offer advantages of treating abdominal wall laxity and repair of larger defects when compared to laparoscopic approaches.
Collapse
|
43
|
Wu J, Xue X, Bi J, Fang G. Unusual presentation of lumbar swelling. ANZ J Surg 2011; 81:753-4. [DOI: 10.1111/j.1445-2197.2011.05855.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
44
|
Intercostal variant of lumbar hernia in lumbocostovertebral syndrome: our experience with 6 cases. J Pediatr Surg 2011; 46:1974-7. [PMID: 22008337 DOI: 10.1016/j.jpedsurg.2011.05.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Revised: 05/10/2011] [Accepted: 05/11/2011] [Indexed: 11/21/2022]
Abstract
Lumbocostovertebral syndrome (LCVS) is a rare type of congenital lumbar hernia. Its features include lumbar hernia associated with genitourinary, vertebral, and rib anomalies. Less than 25 cases have been reported to date. We describe the clinical manifestations and associated anomalies in 6 cases of LCVS managed by us. The patients with suspected LCVS syndrome should be evaluated by detailed clinical history, examination, conventional radiography, magnetic resonance imaging spine, ultrasound abdomen, and echocardiography. The defect can be repaired using local tissues in infancy. There is a need for long-term follow-up for possible late recurrence and scoliosis.
Collapse
|
45
|
Successful laparoscopic repair of a lumbar hernia occurring after iliac bone harvest. Surg Laparosc Endosc Percutan Tech 2011; 20:e38-41. [PMID: 20173609 DOI: 10.1097/sle.0b013e3181c928b9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Many techniques have been described for the surgical repair of lumbar hernias, including primary repair, local tissue flaps, and conventional mesh repair. All these open techniques require a large incision plus extensive dissection to expose the hernia ring. This report presents a case of a recurrent lumbar hernia, which was successfully repaired using a laparoscopic approach. CASE REPORT A 75-year-old female presented with a symptomatic right lumbar hernia, 1-year after an iliac bone harvest for knee surgery. Under general anesthesia, the patient was placed in a lateral decubitus position. A 3 trocar technique was used to do adhesiolysis of the surrounding tissues, to provide an ample working space to identify the hernia. A composix dual mesh (bard) was tailored so that it would overlap the defect with intermittent fixation by a spiral tacker (protac). No hernia recurrence occurred over 2 years after surgery. CONCLUSION The laparoscopic approach has significant advantages for the repair a lumbar hernia: it enables the exact localization of the anatomic defect, and the mesh can be placed deep into the defect, thus allowing the intraabdominal pressure to hold it in position.
Collapse
|
46
|
Abstract
Background. Lumbar hernia is a rare hernia arising through posterolateral abdominal wall defects. Different techniques of repair are reported in the literature. Methods. The authors present their experience of 4 lumbar hernias during a short span of 9 months. All surgical repairs were performed using synthetic mesh placed in the extraperitoneal space, below the muscular layers, using a sutureless tension-free technique. Results. The patients were 3 children and 1 adult, all males. All hernias were through superior triangle. Duration of surgery ranged between 60 and 80 minutes. There were no surgical complications. The mean hospital stay was 2.5 days. All patients are well on follow-up till date. Conclusions. Sutureless tension-free meshplasty of these rare hernias can be successfully performed with the posterior approach. This method of repair is easy, safe, and effective.
Collapse
Affiliation(s)
| | | | - Gulab Patel
- Government Medical College, Surat, Gujarat, India
| | | |
Collapse
|
47
|
Witherspoon J, Chakravartty S, Parry CR, Williams GL, Stephenson BM. Open sutureless lumbar hernia repair using a ‘memory ring’ patch. Hernia 2010; 16:227-8. [DOI: 10.1007/s10029-010-0738-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Accepted: 10/03/2010] [Indexed: 11/29/2022]
|
48
|
Lyngdoh TS, Mahalik S, Naredi B, Samujh R, Khanna S. Lumbocostovertebral syndrome with associated VACTERL anomaly. J Pediatr Surg 2010; 45:e15-7. [PMID: 20850610 DOI: 10.1016/j.jpedsurg.2010.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2010] [Revised: 04/21/2010] [Accepted: 06/01/2010] [Indexed: 10/19/2022]
Abstract
Lumbocostovertebral syndrome is a rare clinical association syndrome rarely accompanied by associated VACTERL anomalies. Only one similar case has been reported previously. We describe the second case, where a male neonate born at 38 weeks of gestation had an unusually high number of congenital anomalies including thoracic hemivertebrae with kyphoscoliosis, a high anorectal malformation, dextrocardia with an atrial septal defect, renal pelvic pyelectasis, hypospadias, and congenital talipes equinovarus.
Collapse
Affiliation(s)
- Toijam S Lyngdoh
- Post Graduate Institute of Medical Education & Research, Chandigarh, India.
| | | | | | | | | |
Collapse
|
49
|
Light D, Gopinath B, Banerjee A, Ratnasingham K. Incarcerated lumbar hernia: a rare presentation. Ann R Coll Surg Engl 2010; 92:W13-4. [PMID: 20412661 DOI: 10.1308/147870810x12659688851393] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This case illustrates the diagnostic uncertainty seen in lumbar herniation as a rare cause of large bowel obstruction.
Collapse
Affiliation(s)
- D Light
- Department of General Surgery, North Tees and Hartlepool NHS Trust, North Tees Hospital, Stockton-on-Tees, UK.
| | | | | | | |
Collapse
|