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Salvino MJ, Ayuso SA, Lorenz WR, Holland AM, Kercher KW, Augenstein VA, Heniford BT. Open repair of flank and lumbar hernias: 142 consecutive repairs at a high-volume hernia center. Am J Surg 2024; 234:136-142. [PMID: 38627142 DOI: 10.1016/j.amjsurg.2024.04.014] [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: 01/27/2024] [Accepted: 04/10/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND Flank and lumbar hernias (FLH) are challenging to repair. This study aimed to establish a reproducible management strategy and analyze elective flank and lumbar repair (FLHR) outcomes from a single institution. METHODS A prospective analysis using a hernia-specific database was performed examining patients undergoing open FLHR between 2004 and 2021. Variables included patient demographics and operative characteristics. RESULTS Of 142 patients, 106 presented with flank hernias, and 36 with lumbar hernias. Patients, primarily ASA Class 2 or 3, exhibited a mean age of 57.0 ± 13.4 years and BMI of 30.2 ± 5.7 kg/m2. Repairs predominantly utilized synthetic mesh in the preperitoneal space (95.1 %). After 29.9 ± 13.1 months follow-up, wound infections occurred in 8.3 %; hernia recurrence was 3.5 %. At 6 months postoperatively, 21.2 % of patients reported chronic pain with two-thirds of these individuals having preoperative pain. CONCLUSIONS Open preperitoneal FLHR provides a durable repair with low complication and hernia recurrence rates over 2.5 years of follow-up.
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Affiliation(s)
- Matthew J Salvino
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Sullivan A Ayuso
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - William R Lorenz
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Alexis M Holland
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Kent W Kercher
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Vedra A Augenstein
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - B Todd Heniford
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA.
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2
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Neris R, Yglesias B. Robotic-Assisted Laparoscopic Repair of Petit's Hernia With Preperitoneal Mesh. Cureus 2024; 16:e63771. [PMID: 38966780 PMCID: PMC11223742 DOI: 10.7759/cureus.63771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2024] [Indexed: 07/06/2024] Open
Abstract
Lumbar hernias are rare abdominal wall hernias that occur in the posterolateral abdominal wall. Intra-peritoneal or extra-peritoneal contents typically protrude through defects in one of two anatomical triangles. The superior lumbar triangle (Grynfeltt-Lesshaft triangle) is an inverted triangle bordered by the 12th rib superiorly, the internal oblique muscle laterally, and the erector spinae muscle medially. The inferior lumbar triangle (Petit's triangle) is an upright triangle bordered by the iliac crest inferiorly, the external oblique muscle laterally, and the latissimus dorsi muscle medially. Surgical repair has been described via open or laparoscopic approach. A 69-year-old male patient presented with right flank pain and swelling. He was involved in a motorcycle accident 10 months prior, which likely resulted in the development of a traumatic lumbar hernia which was demonstrated on the CT scan. The hernia was clinically incarcerated, and the defect contained the cecum and ileocecal valve. The defect was noted just superior to the iliac crest, by definition, making this an inferior lumbar hernia or a Petit's hernia. The hernia was repaired via robotic-assisted laparoscopic transabdominal approach. A peritoneal flap was created exposing the fascial defect. The fascia was primarily repaired with suture. The defect was reinforced with an 11.4 cm round Ventralight ST mesh in the preperitoneal space. The patient tolerated the procedure well with no acute complications. He was discharged the same day as an outpatient with appropriate pain control. Short-term follow-up demonstrated no recurrent hernia present and symptoms resolved. Lumbar hernias are a rare occurrence with no gold standard technique for repair. The benefits of the laparoscopic approach have been described over the open approach. This case report describes utilizing a minimally invasive approach to primarily repair a lumbar hernia defect while also reinforcing the hernia with mesh in the preperitoneal space.
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Affiliation(s)
- Rubén Neris
- General Surgery, Trumbull Regional Medical Center, Warren, USA
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3
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Mizuno R, Honma S. Endoscopic retroperitoneal repair of superior lumbar hernia (Grynfeltt hernia) using self-fixating mesh to prevent nerve injury: a case report. Surg Case Rep 2024; 10:52. [PMID: 38441792 PMCID: PMC10914653 DOI: 10.1186/s40792-024-01846-5] [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: 01/07/2024] [Accepted: 02/13/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND The primary superior lumbar hernia, also called the Grynfeltt Hernia, is a rare entity; hence, a standard surgical repair method has not been established. It is important for this repair procedure not only to prevent recurrence by placing an adequate size of mesh but also to avoid nerve injury. The endoscopic retroperitoneal approach is considered a useful technique for this procedure, requiring no mobilization of the colon and providing good visibility of the surrounding nerves. A self-fixating mesh does not require a traumatic fixation, which is considered advantageous for nerve preservation. CASE PRESENTATION A 72-year-old woman, complaining of left lumbar swelling, was diagnosed with a primary left superior lumbar hernia and underwent endoscopic retroperitoneal hernia repair. With the patient in the right lateral decubitus position, five small ports were inserted, and the retroperitoneal space was dissected. The 2.0 × 1.0-cm hernial orifice was found, and the 12th subcostal nerve above the hernial orifice and the iliohypogastric and the ilioinguinal nerves below the hernial orifice were identified. A 15 × 10-cm self-fixating mesh was placed in the retroperitoneal space without mesh tacking. The postoperative course was uneventful, and the patient was discharged on the first postoperative day. Two years after surgery, there was no sign of recurrence, and chronic pain and neuropathic symptoms were absent. CONCLUSIONS Endoscopic retroperitoneal repair of primary superior lumbar hernia using a self-fixating mesh seems to be useful for nerve preservation.
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Affiliation(s)
- Ryosuke Mizuno
- Department of Surgery, Kobe City Medical Center West Hospital, 2-4, Ichibancho, Nagataku, Kobe, Hyogo, 653-0013, Japan
| | - Shusaku Honma
- Department of Surgery, Kobe City Medical Center West Hospital, 2-4, Ichibancho, Nagataku, Kobe, Hyogo, 653-0013, Japan.
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4
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Li H, Cheng Z, Yan W, Hu X, Wang J. Retroperitoneal totally endoscopic prosthetic repair of lumbar hernia. Sci Rep 2023; 13:20736. [PMID: 38007514 PMCID: PMC10676431 DOI: 10.1038/s41598-023-48226-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 11/23/2023] [Indexed: 11/27/2023] Open
Abstract
Lumbar hernia is a rare lateral abdominal wall hernia. Various surgical repair strategies have been recorded, but there is currently no unified standard. A Chinese surgeon recently revealed a novel technique for treating primary lumbar hernia called retroperitoneal totally endoscopic prosthetic repair (R-TEP). We have made a further exploration of this method and successfully used it in the treatment of secondary lumbar hernia. We successfully performed R-TEP on three patients with lumbar hernias. All patients were female with an average age of 64 years (51-71 years). Two patients each had a primary upper lumbar hernia, while one patient had a secondary lumbar hernia. With a mean operative time of 77 min (60-105 min), all operations were performed successfully. The average visual analogue scale (VAS) was 1.3 points (1-2 points) on the second day following surgery. The mean postoperative hospital stay was 2.3 days (2-3 days). No postoperative complications occurred. During a mean follow-up period of 19 months (10-24 months), there was no recurrence of the hernia, chronic pain or mesh infection. Therefore, R-TEP is safe and effective for both primary and secondary lumbar hernia. Anti-adhesive coated meshes are not required, making this a cost-effective procedure that is worthy of recommendation.
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Affiliation(s)
- Haoran Li
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wannan Medical College, 2 Zheshan West Road, Wuhu, 241000, Anhui Province, China
| | - Zhengwu Cheng
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wannan Medical College, 2 Zheshan West Road, Wuhu, 241000, Anhui Province, China
| | - Wenwu Yan
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wannan Medical College, 2 Zheshan West Road, Wuhu, 241000, Anhui Province, China
| | - Xunzi Hu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wannan Medical College, 2 Zheshan West Road, Wuhu, 241000, Anhui Province, China
| | - Junfeng Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wannan Medical College, 2 Zheshan West Road, Wuhu, 241000, Anhui Province, China.
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Campanile FC, Podda M, Pecchini F, Inama M, Molfino S, Bonino MA, Ortenzi M, Silecchia G, Agresta F, Cinquini M. Laparoscopic treatment of ventral hernias: the Italian national guidelines. Updates Surg 2023:10.1007/s13304-023-01534-3. [PMID: 37217637 PMCID: PMC10202362 DOI: 10.1007/s13304-023-01534-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 05/10/2023] [Indexed: 05/24/2023]
Abstract
Primary and incisional ventral hernias are significant public health issues for their prevalence, variability of professional practices, and high costs associated with the treatment In 2019, the Board of Directors of the Italian Society for Endoscopic Surgery (SICE) promoted the development of new guidelines on the laparoscopic treatment of ventral hernias, according to the new national regulation. In 2022, the guideline was accepted by the government agency, and it was published, in Italian, on the SNLG website. Here, we report the adopted methodology and the guideline's recommendations, as established in its diffusion policy. This guideline is produced according to the methodology indicated by the SNGL and applying the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) methodology. Fifteen recommendations were produced as a result of 4 PICO questions. The level of recommendation was conditional for 12 of them and conditional to moderate for one. This guideline's strengths include relying on an extensive systematic review of the literature and applying a rigorous GRADE method. It also has several limitations. The literature on the topic is continuously and rapidly evolving; our results are based on findings that need constant re-appraisal. It is focused only on minimally invasive techniques and cannot consider broader issues (e.g., diagnostics, indication for surgery, pre-habilitation).
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Affiliation(s)
- Fabio Cesare Campanile
- Division of General Surgery, ASL Viterbo, San Giovanni Decollato-Andosilla Hospital, Civita Castellana, Italy
| | - Mauro Podda
- Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | - Francesca Pecchini
- Department of General Surgery, Emergency and New Technologies, Baggiovara General Hospital, AOU Modena, Modena, Italy
| | - Marco Inama
- General and Mininvasive Surgery Department, Pederzoli Hospital, Peschiera del Garda, Verona, Italy
| | - Sarah Molfino
- General Surgery Unit Chirurgia III, ASST Spedali Civili di Brescia, Brescia, Italy
| | | | - Monica Ortenzi
- Department of General and Emergency Surgery, Marche Polytechnic University, Via Conca 71, 60126, Ancona, Italy.
| | - Gianfranco Silecchia
- Department of Medical-Surgical Sciences and Translation Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | | | - Michela Cinquini
- Department of Oncology, Laboratory of Methodology of Sistematic Reviews and Guidelines Production, Istituto di Ricerche Farmacologiche Mario Negri IRCCS., Milan, Italy
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6
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Robotic repair of non-midline hernias. J Robot Surg 2022; 17:1021-1027. [DOI: 10.1007/s11701-022-01509-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 11/25/2022] [Indexed: 12/05/2022]
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7
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Munoz-Rodriguez JM, Lopez-Monclus J, Perez-Flecha M, Robin-Valle de Lersundi A, Blazquez-Hernando LA, Royuela-Vicente A, Garcia-Hernandez JP, Equisoain-Azcona A, Medina-Pedrique M, Garcia-Urena MA. Reverse TAR may be added when necessary in open preperitoneal repair of lateral incisional hernias: a retrospective multicentric cohort study. Surg Endosc 2022; 36:9072-9091. [PMID: 35764844 DOI: 10.1007/s00464-022-09375-8] [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: 03/23/2022] [Accepted: 05/28/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND The best approach for lateral incisional hernia is not known. Posterior component separation (reverse TAR) offers the possibility of using the retromuscular space for medial extension of the challenging preperitoneal plane. The aim of our multicenter study was to compare the operative and patient-reported outcomes measures (PROMs) using two open surgical techniques from the lateral approach: a totally preperitoneal vs a reverse TAR. METHODS A retrospective cohort study was performed since 2012 to 2020. Patients with lateral incisional hernia treated through a lateral approach were identified from a prospectively maintained multicenter database. Reverse TAR was added when the preperitoneal plane could not be safely dissected. The results obtained using these two lateral approaches were compared, including short- and long-term complications, as well as PROMs, using the specific tool EuraHSQoL. RESULTS A total of 61 patients were identified. Reverse TAR was performed in 33 patients and lateral retromuscular preperitoneal approach in 28 patients. Both groups were comparable in terms of sociodemographic and comorbidities variables. Surgical site occurrences occurred in 13 cases (21.3%), with 8 patients (13.1%) requiring procedural intervention. During a median follow-up of 34 months, no incisional hernia recurrence was registered. There was a case (1.6%) of symptomatic bulging that required reoperation. Also 12 patients (19.7%) presented an asymptomatic bulging. No statistically significant difference was identified in the complications and PROMs between the two procedures. CONCLUSION The open lateral retromuscular reconstruction using very large meshes that reach the midline has excellent long-term results with acceptable postoperative complications, including PROMs. A reverse TAR may be added, when necessary, without increasing complications and obtaining similar long-term results.
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Affiliation(s)
- Joaquin M Munoz-Rodriguez
- Puerta de Hierro Majadahonda University Hospital, C. Joaquín Rodrigo, 1, 28222, Majadahonda, Madrid, Spain.,Autónoma de Madrid University, Madrid, Spain
| | - Javier Lopez-Monclus
- Puerta de Hierro Majadahonda University Hospital, C. Joaquín Rodrigo, 1, 28222, Majadahonda, Madrid, Spain. .,Autónoma de Madrid University, Madrid, Spain.
| | - Marina Perez-Flecha
- Henares University Hospital, Av. de Marie Curie, 0, 28822, Coslada, Madrid, Spain.,Complex Abdominal Wall Research Group From Francisco de Vitoria University, Madrid, Spain
| | - Alvaro Robin-Valle de Lersundi
- Henares University Hospital, Av. de Marie Curie, 0, 28822, Coslada, Madrid, Spain.,Complex Abdominal Wall Research Group From Francisco de Vitoria University, Madrid, Spain
| | | | - Ana Royuela-Vicente
- Puerta de Hierro Majadahonda University Hospital, C. Joaquín Rodrigo, 1, 28222, Majadahonda, Madrid, Spain.,Autónoma de Madrid University, Madrid, Spain
| | - Juan P Garcia-Hernandez
- Alcala de Henares University, Campus Universitario-C/ 19, Av. de Madrid, Km 33,600, 28871, Alcalá de Henares, Madrid, Spain
| | - Aritz Equisoain-Azcona
- Puerta de Hierro Majadahonda University Hospital, C. Joaquín Rodrigo, 1, 28222, Majadahonda, Madrid, Spain.,Autónoma de Madrid University, Madrid, Spain
| | - Manuel Medina-Pedrique
- Henares University Hospital, Av. de Marie Curie, 0, 28822, Coslada, Madrid, Spain.,Complex Abdominal Wall Research Group From Francisco de Vitoria University, Madrid, Spain
| | - Miguel A Garcia-Urena
- Henares University Hospital, Av. de Marie Curie, 0, 28822, Coslada, Madrid, Spain.,Complex Abdominal Wall Research Group From Francisco de Vitoria University, Madrid, Spain
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8
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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.
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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.
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9
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Moriyama H, Shimada M, Yoshida S, Takemura H. Reoperation with laparoscopic mesh repair for recurrent lumbar hernia due to iliac crest bone harvest. Asian J Endosc Surg 2021; 14:136-139. [PMID: 32207227 DOI: 10.1111/ases.12798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 02/27/2020] [Accepted: 03/02/2020] [Indexed: 11/28/2022]
Abstract
Previous reports have described laparoscopic mesh repair for lumbar hernia due to iliac crest bone harvest, but there have been no reports of reoperation with laparoscopic mesh repair for recurrent cases after laparoscopic mesh repair. Here, we describe the case of a 72-year-old Japanese woman with lumbar hernia recurrence 6 years after laparoscopic mesh repair for lumbar hernia due to iliac crest bone harvest. We performed a successful reoperation with laparoscopic mesh repair. Laparoscopic surgery should be considered to elucidate the mechanism of recurrence, previous mesh position, and the area that must be covered to prevent recurrence again.
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Affiliation(s)
- Hideki Moriyama
- Department of Thoracic, Cardiovascular, and General Surgery, Kanazawa University, Kanazawa, Japan
| | - Mari Shimada
- Department of Thoracic, Cardiovascular, and General Surgery, Kanazawa University, Kanazawa, Japan
| | - Shuhei Yoshida
- Department of Thoracic, Cardiovascular, and General Surgery, Kanazawa University, Kanazawa, Japan
| | - Hirofumi Takemura
- Department of Thoracic, Cardiovascular, and General Surgery, Kanazawa University, Kanazawa, Japan
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10
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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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11
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Nakahara Y, Wakasugi M, Nagaoka S, Oshima S. Single-incision retroperitoneal laparoscopic repair of superior lumbar hernia using self-fixating ProGrip mesh: A case report. Int J Surg Case Rep 2020; 67:120-122. [PMID: 32062114 PMCID: PMC7016337 DOI: 10.1016/j.ijscr.2020.01.034] [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: 10/26/2019] [Revised: 01/08/2020] [Accepted: 01/26/2020] [Indexed: 11/24/2022] Open
Abstract
Superior lumbar hernia is an uncommon hernia. We performed single-incision retroperitoneal laparoscopic repair. Self-fixating mesh without fixation is useful because of no risk of nerve injury.
Introduction Lumbar hernia is rare and represents less than 1–2% of all abdominal hernias. There are mainly two types of lumbar hernia: superior lumbar hernia and inferior lumbar hernia. Case presentation A 65-year-old woman was admitted complaining of a mass in her left lumbar area. Under a diagnosis of superior lumbar hernia, single-incision laparoscopic retroperitoneal repair was performed. A single, 2-cm-long incision was made and the retroperitoneal space was dissected gradually. The hernia orifice was recognized and hernia sac was slipped from the hernia orifice. The collateral branch of subcostal nerve and iliohypogastric nerve were recognized. Laparoscopic self-fixating mesh was placed to cover the hernia orifice without mesh fixation. The patient remained well with no signs of recurrence. Discussion In laparoscopic lumbar hernia repair, it is important to be careful not to damage subcostal nerve and iliohypogastric nerve. Self-fixating mesh without fixation is useful due to the prevention from nerve injury. To our best knowledge, this is the first report of single-incision laparoscopic repair for superior lumbar hernia. Single-incision laparoscopic surgery could provide good cosmetic results with minimal incision. Conclusion We successfully performed single-incision retroperitoneal laparoscopic repair of superior lumbar hernia using self-fixating mesh.
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Affiliation(s)
- Yujiro Nakahara
- Department of Gastroenterological Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-ku, Osaka, 543-0035, Japan; Department of Surgery, Kinki Central Hospital, 3-1 Kurumaduka, Itami, Hyogo 664-8533, Japan.
| | - Masaki Wakasugi
- Department of Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Kita-ku, Sakai, Osaka, 591-8025, Japan
| | - Satoshi Nagaoka
- Department of Surgery, Kinki Central Hospital, 3-1 Kurumaduka, Itami, Hyogo 664-8533, Japan
| | - Satoshi Oshima
- Department of Surgery, Kinki Central Hospital, 3-1 Kurumaduka, Itami, Hyogo 664-8533, Japan
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12
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Parker SG, Halligan S, Erotocritou M, Wood CPJ, Boulton RW, Plumb AAO, Windsor ACJ, Mallett S. A systematic methodological review of non-randomised interventional studies of elective ventral hernia repair: clear definitions and a standardised minimum dataset are needed. Hernia 2019; 23:859-872. [PMID: 31152271 PMCID: PMC6838456 DOI: 10.1007/s10029-019-01979-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 05/15/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND Ventral hernias (VHs) often recur after surgical repair and subsequent attempts at repair are especially challenging. Rigorous research to reduce recurrence is required but such studies must be well-designed and report representative and comprehensive outcomes. OBJECTIVE We aimed to assesses methodological quality of non-randomised interventional studies of VH repair by systematic review. METHODS We searched the indexed literature for non-randomised studies of interventions for VH repair, January 1995 to December 2017 inclusive. Each prospective study was coupled with a corresponding retrospective study using pre-specified criteria to provide matched, comparable groups. We applied a bespoke methodological tool for hernia trials by combining relevant items from existing published tools. Study introduction and rationale, design, participant inclusion criteria, reported outcomes, and statistical methods were assessed. RESULTS Fifty studies (17,608 patients) were identified: 25 prospective and 25 retrospective. Overall, prospective studies scored marginally higher than retrospective studies for methodological quality, median score 17 (IQR: 14-18) versus 15 (IQR 12-18), respectively. For the sub-categories investigated, prospective studies achieved higher median scores for their, 'introduction', 'study design' and 'participants'. Surprisingly, no study stated that a protocol had been written in advance. Only 18 (36%) studies defined a primary outcome, and only 2 studies (4%) described a power calculation. No study referenced a standardised definition for VH recurrence and detection methods for recurrence varied widely. Methodological quality did not improve with publication year or increasing journal impact factor. CONCLUSION Currently, non-randomised interventional studies of VH repair are methodologically poor. Clear outcome definitions and a standardised minimum dataset are needed.
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Affiliation(s)
- S G Parker
- The Abdominal Wall Unit UCLH, GI Services Department, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK.
| | - S Halligan
- UCL Centre for Medical Imaging, 2nd Floor Charles Bell House, 43-45 Foley Street, London, W1W 7TS, UK
| | - M Erotocritou
- The Abdominal Wall Unit UCLH, GI Services Department, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - C P J Wood
- The Abdominal Wall Unit UCLH, GI Services Department, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - R W Boulton
- The Abdominal Wall Unit UCLH, GI Services Department, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - A A O Plumb
- UCL Centre for Medical Imaging, 2nd Floor Charles Bell House, 43-45 Foley Street, London, W1W 7TS, UK
| | - A C J Windsor
- The Abdominal Wall Unit UCLH, GI Services Department, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - S Mallett
- The Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
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13
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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.
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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
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14
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van Steensel S, Bloemen A, van den Hil LCL, van den Bos J, Kleinrensink GJ, Bouvy ND. Pitfalls and clinical recommendations for the primary lumbar hernia based on a systematic review of the literature. Hernia 2019; 23:107-117. [PMID: 30315438 PMCID: PMC6394702 DOI: 10.1007/s10029-018-1834-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 10/01/2018] [Indexed: 11/18/2022]
Abstract
PURPOSE The lumbar abdominal wall hernia is a rare hernia in which abdominal contents protrude through a defect in the dorsal abdominal wall, which can be of iatrogenic, congenital, or traumatic origin. Two anatomical locations are known: the superior and the inferior lumbar triangle. The aim of this systematic review is to provide a clear overview of the existing literature and make practical clinical recommendations for proper diagnosis and treatment of the primary lumbar hernia. METHODS The systematic review was conducted according to the PRISMA guidelines. A systematic search in PubMed, MEDLINE, and EMBASE was performed, and all studies reporting on primary lumbar hernias were included. No exclusion based on study design was performed. Data regarding incarceration, recurrence, complications, and surgical management were extracted. RESULTS Out of 670 eligible articles, 14 were included and additional single case reports were analysed separately. The average quality of the included articles was 4.7 on the MINORS index (0-16). Risk factors are related to increased intra-abdominal pressure. CT scanning should be performed during pre-operative workup. Available evidence favours laparoscopic mesh reinforcement, saving open repair for larger defects. Incarceration was observed in 30.8% of the cases and 2.0% had a recurrence after surgical repair. Hematomas and seromas are common complications, but surgical site infections are relatively rare. CONCLUSION The high risks of incarceration in lumbar hernias demand a relatively fast elective repair. The use of a mesh is recommended, but the surgical approach should be tailored to individual patient characteristics and risk factors.
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Affiliation(s)
- S van Steensel
- Department of General Surgery, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - A Bloemen
- Department of General Surgery, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
- Department of Surgery, VieCuri Medical Centre, Venlo, The Netherlands
| | - L C L van den Hil
- Department of General Surgery, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - J van den Bos
- Department of General Surgery, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - G J Kleinrensink
- Department of Neuroscience, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - N D Bouvy
- Department of General Surgery, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.
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15
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Amaral PHF, Tastaldi L, Barros PHF, Abreu Neto IP, Hernani BL, Brasil H, Mendes CJL, Franciss MY, Pacheco AM, Altenfelder Silva R, Roll S. Combined open and laparoscopic approach for repair of flank hernias: technique description and medium-term outcomes of a single surgeon. Hernia 2019; 23:157-165. [PMID: 30697653 DOI: 10.1007/s10029-019-01880-5] [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: 07/23/2018] [Accepted: 01/02/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE A residual bulge in the lateral abdominal wall is a reason for patient dissatisfaction after flank hernia repair (FHR). We hypothesized that combining a laparoscopically-placed intraperitoneal mesh (IPOM) with onlay hernia repair performed through a small open incision would increase repair durability and decrease such residual bulges. We aim to report our medium-term outcomes with this technique. METHODS Patients who have undergone FHR using the technique described above from March 2013 through June 2017 were identified in a prospectively maintained database. Outcomes of interest included surgical site infections (SSI), surgical site occurrences (SSO), surgical site occurrences requiring procedural intervention (SSOPI) and hernia recurrence. RESULTS Sixteen patients were identified (62% females; mean age 59 ± 8 years, mean body mass index 29.5 kg/m2). Mean hernia width was. 6.4 ± 3 cm and 31% were recurrent hernias previously repaired through an onlay approach. Mean operative time was 159 ± 40 min, fascial closure was achieved in all cases, and there were no intraoperative complications. Median length of stay was 3 days (IQR 3-4), and there were no unplanned readmissions or reoperations. At a median 37-month follow-up (IQR 21-55), wound morbidity rate was 12.5% (2 seromas). There were no SSI/SSOPI and one hernia recurrence (6%) was detected at 12 months postoperatively. CONCLUSION Combining laparoscopic IPOM with open onlay hernia repair resulted in low recurrence and acceptable wound morbidity rates, with no residual bulges noted at medium-term follow-up. Further studies with larger number of patients and other surgeon's experiences are necessary to determine the role of such technique in the surgical armamentarium for flank hernia repair.
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Affiliation(s)
- P H F Amaral
- Hernia Center, Hospital Alemão Oswaldo Cruz, R. Treze de Maio, 1815, 01327-001, São Paulo, SP, Brazil. .,Abdominal Wall Surgery Group, Department of Surgery, Irmandade da Santa Casa de Misericórdia de São Paulo, R. Dr. Cesário Mota Júnior, 112., 01221-020, São Paulo, SP, Brazil.
| | - L Tastaldi
- Comprehensive Hernia Center, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue A10-133, Cleveland, OH, 44195, USA
| | - P H F Barros
- Hernia Center, Hospital Alemão Oswaldo Cruz, R. Treze de Maio, 1815, 01327-001, São Paulo, SP, Brazil.,Abdominal Wall Surgery Group, Department of Surgery, Irmandade da Santa Casa de Misericórdia de São Paulo, R. Dr. Cesário Mota Júnior, 112., 01221-020, São Paulo, SP, Brazil
| | - I P Abreu Neto
- Hernia Center, Hospital Alemão Oswaldo Cruz, R. Treze de Maio, 1815, 01327-001, São Paulo, SP, Brazil.,Abdominal Wall Surgery Group, Department of Surgery, Irmandade da Santa Casa de Misericórdia de São Paulo, R. Dr. Cesário Mota Júnior, 112., 01221-020, São Paulo, SP, Brazil
| | - B L Hernani
- Hernia Center, Hospital Alemão Oswaldo Cruz, R. Treze de Maio, 1815, 01327-001, São Paulo, SP, Brazil.,Abdominal Wall Surgery Group, Department of Surgery, Irmandade da Santa Casa de Misericórdia de São Paulo, R. Dr. Cesário Mota Júnior, 112., 01221-020, São Paulo, SP, Brazil
| | - H Brasil
- Abdominal Wall Surgery Group, Department of Surgery, Irmandade da Santa Casa de Misericórdia de São Paulo, R. Dr. Cesário Mota Júnior, 112., 01221-020, São Paulo, SP, Brazil
| | - C J L Mendes
- Abdominal Wall Surgery Group, Department of Surgery, Irmandade da Santa Casa de Misericórdia de São Paulo, R. Dr. Cesário Mota Júnior, 112., 01221-020, São Paulo, SP, Brazil
| | - M Y Franciss
- Abdominal Wall Surgery Group, Department of Surgery, Irmandade da Santa Casa de Misericórdia de São Paulo, R. Dr. Cesário Mota Júnior, 112., 01221-020, São Paulo, SP, Brazil
| | - A M Pacheco
- Abdominal Wall Surgery Group, Department of Surgery, Irmandade da Santa Casa de Misericórdia de São Paulo, R. Dr. Cesário Mota Júnior, 112., 01221-020, São Paulo, SP, Brazil
| | - R Altenfelder Silva
- Abdominal Wall Surgery Group, Department of Surgery, Irmandade da Santa Casa de Misericórdia de São Paulo, R. Dr. Cesário Mota Júnior, 112., 01221-020, São Paulo, SP, Brazil
| | - S Roll
- Hernia Center, Hospital Alemão Oswaldo Cruz, R. Treze de Maio, 1815, 01327-001, São Paulo, SP, Brazil.,Abdominal Wall Surgery Group, Department of Surgery, Irmandade da Santa Casa de Misericórdia de São Paulo, R. Dr. Cesário Mota Júnior, 112., 01221-020, São Paulo, SP, Brazil
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16
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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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17
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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.
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18
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Postoperative-treatment following open incisional hernia repair: A survey and a review of literature. Int J Surg 2018; 53:320-325. [DOI: 10.1016/j.ijsu.2018.04.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 03/12/2018] [Accepted: 04/09/2018] [Indexed: 11/22/2022]
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19
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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.
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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.
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20
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Open Approach to Primary Lumbar Hernia Repair: A Lucid Option. Case Rep Surg 2018. [PMID: 29312793 DOI: 10.1155/2017/5839491.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Lumbar hernia is a rare type of hernia. Awareness of the anatomical basis of this hernia is important for proper diagnosis and treatment. Introduction Lumbar hernia is a protrusion of either extraperitoneal fat or intraperitoneal contents through either of the lumbar triangles. Primary lumbar hernias are extremely rare thereby rendering such a case reportable, to create an awareness about this condition to upcoming surgeons. Case Report A case of primary lumbar hernia treated successfully by open mesh repair is presented. Discussion The anatomical aspects underlying this condition along with diagnostic tests, their pitfalls, and surgical approaches are discussed. Conclusion Awareness of this condition is essential for arriving at a clinical diagnosis. CT scan provides a road map for deciding the approach. Both the traditional open and the newer laparoscopic approaches are described. However open meshplasty is still a very safe and effective method of treatment.
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21
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Vagholkar K, Vagholkar S. Open Approach to Primary Lumbar Hernia Repair: A Lucid Option. Case Rep Surg 2017; 2017:5839491. [PMID: 29312793 PMCID: PMC5664275 DOI: 10.1155/2017/5839491] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 09/19/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Lumbar hernia is a rare type of hernia. Awareness of the anatomical basis of this hernia is important for proper diagnosis and treatment. INTRODUCTION Lumbar hernia is a protrusion of either extraperitoneal fat or intraperitoneal contents through either of the lumbar triangles. Primary lumbar hernias are extremely rare thereby rendering such a case reportable, to create an awareness about this condition to upcoming surgeons. CASE REPORT A case of primary lumbar hernia treated successfully by open mesh repair is presented. DISCUSSION The anatomical aspects underlying this condition along with diagnostic tests, their pitfalls, and surgical approaches are discussed. CONCLUSION Awareness of this condition is essential for arriving at a clinical diagnosis. CT scan provides a road map for deciding the approach. Both the traditional open and the newer laparoscopic approaches are described. However open meshplasty is still a very safe and effective method of treatment.
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Affiliation(s)
- Ketan Vagholkar
- Department of Surgery, D. Y. Patil University School of Medicine, Nerul, Navi Mumbai 400706, India
| | - Suvarna Vagholkar
- Department of Surgery, D. Y. Patil University School of Medicine, Nerul, Navi Mumbai 400706, India
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22
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Matsuda A, Miyashita M, Matsumoto S, Sakurazawa N, Kawano Y, Matsutani T, Uchida E. Laparoscopic mesh repair for lumbar hernia after iliac crest bone harvest. Asian J Endosc Surg 2016; 9:314-317. [PMID: 27491627 DOI: 10.1111/ases.12308] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 05/29/2016] [Accepted: 06/12/2016] [Indexed: 11/30/2022]
Abstract
Lumbar hernia after iliac crest bone harvest is relatively rare. When it does occur, it presents as a flank abdominal protrusion through a lateroposterior abdominal wall defect. A laparoscopic approach for this type of hernia is reported to have advantages over the classic open method. Here, we present a case of a 49-year-old Caucasian man who presented with an enlarged left flank mass after iliac bone harvest for pseudarthrosis. He had undergone open onlay mesh repair for inferior lumbar hernia, but the hernia recurred 3 months postoperatively. Laparoscopic intraperitoneal onlay mesh repair using a composite mesh was performed 7 months after recurrence. The patient was discharged 6 days postoperatively without complications. No signs of recurrence were detected during 1-year follow-up period. The laparoscopic approach for lumbar hernia conferred excellent visualization of the hernia defect and enabled a safe mesh repair using intra-abdominal pressure to hold it in position. This approach provided all the benefits of minimally invasive surgery.
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Affiliation(s)
- Akihisa Matsuda
- Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Japan.
| | - Masao Miyashita
- Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Japan
| | - Satoshi Matsumoto
- Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Japan
| | - Nobuyuki Sakurazawa
- Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Japan
| | - Yoichi Kawano
- Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Japan
| | - Takeshi Matsutani
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan
| | - Eiji Uchida
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan
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24
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Sun J, Chen X, Li J, Zhang Y, Dong F, Zheng M. Implementation of the trans-abdominal partial extra-peritoneal (TAPE) technique in laparoscopic lumbar hernia repair. BMC Surg 2015; 15:118. [PMID: 26507827 PMCID: PMC4624658 DOI: 10.1186/s12893-015-0104-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Accepted: 10/16/2015] [Indexed: 12/13/2022] Open
Abstract
Background There is still not any standardized operative strategy that is well-accepted all over the world for lumbarhernia. We are here to investigate the feasibility of the trans-abdominal partial extra-peritoneal (TAPE) technique in lumbar hernia repair. Methods The TAPE technique was applied to 14 patients with lumbar hernia from May 2009 until January 2014. The surgical technique was described in details and follow-ups were performed for further evaluation. Results The mean age of the 14 patients was 68 ± 8 years, with the average BMI 25.5 ± 2.1 kg/m2. The etiology study showed that 13 cases after surgical operations and one case after trauma. The average size of the hernia defect was 86.8 ± 46.4 cm2, while the mean size of the mesh implanted was 275 ± 61.2 cm2. The mean operative time was 59.2 ± 8.2 min. There was no intra-operative visceral injury in this serial of cases. There was no conversion case and all patients accepted the TAPE technique successfully. The VAS was 3.8 ± 1.9 and 2.2 ± 1.6 on POD1 and POD3, respectively. The mean post-operative hospital stay was 4.0 ± 1.3 days. The median follow-up time was 33 months. All patients returned to unrestricted movement within 2 weeks after surgery. During the follow-ups, no complication as bulge, seroma, hematoma, wound infection, abscess in surgical area and chronic pain, nor recurrence was observed. Conclusions According to our experience in this series of investigations, the TAPE could be a feasible and easy-to-learn technique which can be applied to most of the lumbar hernia repairs.
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Affiliation(s)
- Jing Sun
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, P.R. China.,Shanghai Minimally Invasive Surgery Center, Shanghai, 200025, P.R. China
| | - Xin Chen
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, P.R. China.,Shanghai Minimally Invasive Surgery Center, Shanghai, 200025, P.R. China
| | - Jianwen Li
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, P.R. China. .,Shanghai Minimally Invasive Surgery Center, Shanghai, 200025, P.R. China.
| | - Yun Zhang
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, P.R. China.,Shanghai Minimally Invasive Surgery Center, Shanghai, 200025, P.R. China
| | - Feng Dong
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, P.R. China.,Shanghai Minimally Invasive Surgery Center, Shanghai, 200025, P.R. China
| | - Minhua Zheng
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, P.R. China. .,Shanghai Minimally Invasive Surgery Center, Shanghai, 200025, P.R. China.
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25
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Silecchia G, Campanile FC, Sanchez L, Ceccarelli G, Antinori A, Ansaloni L, Olmi S, Ferrari GC, Cuccurullo D, Baccari P, Agresta F, Vettoretto N, Piccoli M. Laparoscopic ventral/incisional hernia repair: updated Consensus Development Conference based guidelines [corrected]. Surg Endosc 2015; 29:2463-84. [PMID: 26139480 DOI: 10.1007/s00464-015-4293-8] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 04/27/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND The Executive board of the Italian Society for Endoscopic Surgery (SICE) promoted an update of the first evidence-based Italian Consensus Conference Guidelines 2010 because a large amount of literature has been published in the last 4 years about the topics examined and new relevant issues. METHODS The scientific committee selected the topics to be addressed: indications to surgical treatment including special conditions (obesity, cirrhosis, diastasis recti abdominis, acute presentation); safety and outcome of intraperitoneal meshes (synthetic and biologic); fixing devices (absorbable/non-absorbable); abdominal border and parastomal hernia; intraoperative and perioperative complications; and recurrent ventral/incisional hernia. All the recommendations are the result of a careful and complete literature review examined with autonomous judgment by the entire panel. The process was supervised by experts in methodology and epidemiology from the most qualified Italian institution. Two external reviewers were designed by the EAES and EHS to guarantee the most objective, transparent, and reliable work. The Oxford hierarchy (OCEBM Levels of Evidence Working Group*. "The Oxford 2011 Levels of Evidence") was used by the panel to grade clinical outcomes according to levels of evidence. The recommendations were based on the grading system suggested by the GRADE working group. RESULTS AND CONCLUSIONS The availability of recent level 1 evidence (a meta-analysis of 10 RCTs) allowed to recommend that not only laparoscopic repair is an acceptable alternative to the open repair, but also it is advantageous in terms of shorter hospital stay and wound infection rate. This conclusion appears to be extremely relevant in a clinical setting. Indications about specific conditions could also be issued: laparoscopy is recommended for the treatment of recurrent ventral hernias and obese patients, while it is a potential option for compensated cirrhotic and childbearing-age female patients. Many relevant and controversial topics were thoroughly examined by this consensus conference for the first time. Among them are the issue of safety of the intraperitoneal mesh placement, traditionally considered a major drawback of the laparoscopic technique, the role for the biologic meshes, and various aspects of the laparoscopic approach for particular locations of the defect such as the abdominal border or parastomal hernias.
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Affiliation(s)
- Gianfranco Silecchia
- Division of General Surgery and Bariatric Centre of Excellence, Department of Medico-Surgical Sciences and Biotechnology, Sapienza University of Rome, Via Faggiana 1668, 04100, Latina, LT, Italy
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26
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Laparoscopic ventral hernia repair: outcomes in primary versus incisional hernias: no effect of defect closure. Hernia 2015; 19:479-86. [PMID: 25663605 DOI: 10.1007/s10029-015-1345-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Accepted: 01/17/2015] [Indexed: 01/10/2023]
Abstract
PURPOSE Supposing divergent aetiology, we found it interesting to investigate outcomes between primary (PH) versus incisional (IH) hernias. In addition, we wanted to analyse the effect of defect closure and mesh fixation techniques. METHODS 37 patients with PH and 70 with IH were enrolled in a prospective cohort-study, treated with laparoscopic ventral hernia repair (LVHR) and randomised to ± transfascial sutures. In addition, we analysed results from a retrospective study with 36 PH and 51 IH patients. Mean follow-up time was 38 months in the prospective study and 27 months in the retrospective study. RESULTS 35 % of PH's and 10 % of IH's were recurrences after previous suture repair. No late infections or mesh removals occurred. Recurrence rates in the prospective study were 0 vs. 4.3 % (p = 0.55) and the complication rates were 16 vs. 27 % (p = 0.24) in favour of the PH cohort. The IH group had a mesh protrusion rate of 13 vs. 5 % in the PH group (p = 0.32), and significantly (p < 0.01) larger hernias and adhesion score, longer operating time (100 vs. 79 min) and admission time (2.8 vs. 1.6 days). Closure of the hernia defect did not influence rate of seroma, pain at 2 months, protrusion or recurrence. An overall increased complication rate was seen after defect closure (OR 3.42; CI 1.25-9.33). CONCLUSIONS With PH, in comparison to IH treated with LVHR, no differences were observed regarding recurrence, protrusion or complication rates. Defect closure (raphe), when using absorbable suture, did not benefit long-term outcomes and caused a higher overall complication rate. (ClinicalTrials.gov number: NCT00455299).
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Park SH, Chung HS, Song SH. Lumbar hernia in South Korea: different from that in foreign literature? Hernia 2014; 19:835-9. [PMID: 25504452 DOI: 10.1007/s10029-014-1333-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 12/02/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE This study aimed to analyze the clinical features of lumbar hernia reported in South Korea and compare these features with those reported in foreign literature. METHODS From January 1968 through December 2013, 13 cases reported in South Korea were included in the study. The variables compared were age, sex, main symptoms at hospital visit, etiology, location, herniated contents, lateralization, defect size, diagnostic methods, surgical methods, surgical opinions, and recurrence. RESULTS In the South Korean cases, women outnumbered men (3.3:1) and no significant differences were found in the herniated side (left:right, 1.1:1). In contrast, in the foreign cases, men outnumbered women (3:1) and left-sided hernia was dominant (2:1). Moreover, in most of the foreign cases, patients were aged 50-70 years, whereas in the South Korean cases, none of the patients were in their 50 s. However, no substantial differences were found in etiology, anatomical locations, symptoms, and herniated contents. CONCLUSION This research revealed that few clinical features of lumbar hernias in South Korea differ from those reported in foreign literature. Thirteen cases were analyzed in the present study, and results obtained from such a small sample size cannot be generalized with certainty. Therefore, more cases should be collected for a definitive analysis. Despite this limitation, this study is important because it is the first attempt to collect and analyze the clinical features of lumbar hernia in South Korea. This study will serve as a basis for future studies investigating the clinical features of lumbar hernia cases in South Korea.
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Affiliation(s)
- S H Park
- Department of Clinical Pharmacy, College of Pharmacy, Chosun University, Gwangju, South Korea
| | - H S Chung
- Department of Surgery, Gwangju Veterans Hospital, 99 Cheomdanwolbong-ro, Gwangsan-gu, Gwangju, South Korea.
- Department of Surgery, College of Medicine, Chosun University, Gwangju, South Korea.
| | - S H Song
- Department of Surgery, Gwangju Veterans Hospital, 99 Cheomdanwolbong-ro, Gwangsan-gu, Gwangju, South Korea
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Lal R, Sharma D, Hazrah P, Kumar P, Borgharia S, Agarwal A. Laparoscopic Management of Nonmidline Ventral Hernia. J Laparoendosc Adv Surg Tech A 2014; 24:445-50. [DOI: 10.1089/lap.2013.0381] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Romesh Lal
- Department of Surgery, Lady Hardinge Medical College & Dr. RML Hospital, New Delhi, India
| | - Deborshi Sharma
- Department of Surgery, Lady Hardinge Medical College & Dr. RML Hospital, New Delhi, India
| | - Priya Hazrah
- Department of Surgery, Lady Hardinge Medical College & Dr. RML Hospital, New Delhi, India
| | - Pawan Kumar
- Department of Surgery, Lady Hardinge Medical College & Dr. RML Hospital, New Delhi, India
| | - Saurabh Borgharia
- Department of Surgery, Lady Hardinge Medical College & Dr. RML Hospital, New Delhi, India
| | - Abhinav Agarwal
- Department of Surgery, Lady Hardinge Medical College & Dr. RML Hospital, New Delhi, India
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Ahmed ST, Ranjan R, Saha SB, Singh B. Lumbar hernia: a diagnostic dilemma. BMJ Case Rep 2014; 2014:bcr-2013-202085. [PMID: 24810439 DOI: 10.1136/bcr-2013-202085] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Lumbar hernia is one of the rare cases that most surgeons are not exposed to. Hence the diagnosis can be easily missed. This leads to delay in the treatment causing increased morbidity. We report a case of lumbar hernia in a middle-aged woman. It was misdiagnosed as lipoma by another surgeon. It was a case of primary acquired lumbar hernia in the superior lumbar triangle. Clinical and MRI findings were correlated to reach the diagnosis. We also highlight the types, the process of diagnosis and the surgical repair of lumbar hernias. We wish to alert our fellow surgeons to keep the differential diagnosis of the lumbar hernia in mind before diagnosing any lumbar swelling as lipoma.
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Affiliation(s)
- Syed Tausif Ahmed
- Department of General Surgery, Bankura Sammilani Medical College, Kolkata, West Bengal, India
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