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Take down of the white line of Toldt of the splenic flexure to allow placement of an adequately sized mesh.
Source publication
Lumbar hernias, rarely seen in clinical practice, can be acquired after open or laparoscopic flank surgery. We describe a successful laparoscopic preperitoneal mesh repair of multiple trocar-site hernias after extraperitoneal nephrectomy. All the key steps including creating a peritoneal flap, reducing the hernia contents, and fixation of the mesh...
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Background
The outcome of incisional and ventral hernia repair depends on surgical technique, patient, and material. Permacol™ surgical implant (crosslinked porcine collagen) has been used for over a decade; however, there are few data on outcomes. This study is the largest retrospective multinational study to date to evaluate outcomes with Permaco...
Citations
... On the contrary, previous surgeries, penetrating wounds, and infections represent risk factors for the development of secondary and therefore iatrogenic lumbar hernias 26 . Nephrectomies with retroperitoneal access are reported to be most at risk for developing Grynfeltt secondary hernia ,as well as repair of retroperitoneal aortic aneurysms, and latissimus dorsal aps for post-mastectomy breast reconstruction due to denervation of lumbar dorsal muscle components [27][28][29][30][31] . In the literature, there is a predominance of left Grynfeltt hernia while a bilateral presentation is exceptional. ...
Grynfeltt's lumbar hernia, from the author who first described it in 1866, is the rarest among all hernias of the abdominal wall and it represents, according to the most recent literature, only 2% of all hernias. Of these, about 20% are congenital, secondary mainly to defects of embryonic development, while 80% are acquired defects. Surgeries, penetrating wounds, and infections are risk factors for the development of secondary and therefore iatrogenic lumbar hernias. In the literature, there is a predominance of the left Grynfeltt hernia while a bilateral presentation is exceptional. Our recent observation of a massive Grynfeltt hernia brought us to perform a revision of the literature and of our case studies. Based on our personal experience, with the most recent literature, we believe that in the case of Grynfeltt's lumbar hernias, the laparotomy approach with the use of prosthetic materials is the most appropriate, thus making the procedure fast, easy, and safe, compared to the treatment of all other wall defects that often require a laparoscopic approach. To confirm this, it is perceived that the open technique is currently more widespread; in fact, a small lumbotomy is easy to perform, fast, and can also be performed under loco-regional or epidural anaesthesia. KEY WORDS: Lumbar hernioplasty, Grynfeltt hernia, Hernia repair.
... Secondary lumbar hernias are either iatrogenic, traumatic, or following infection or inflammation and account for 25% of acquired lumbar hernias [9]. Most incisional lumbar hernias have been described to occur following retroperitoneal nephrectomies, retroperitoneal abdominal aortic aneurysm repairs, or latissimus dorsi flaps for breast reconstruction [10][11][12]. Very few cases of lumbar hernia have been reported following spinal fusion and, to the authors' knowledge, no case has been reported of a bilateral lumbar hernia following multiple spine surgeries [13][14][15]. Most reported bilateral lumbar hernias are congenital and are associated with the diffuse type which presents as aplasia of the lumbar muscles [16]. ...
Lumbar hernias are rare abdominal wall defects. Fewer than 400 cases have been reported in the literature and account for 2% of all abdominal wall hernias. Lumbar hernias are divided into Grynfelt-Lesshaft or Petit hernias. The former are hernia defects through the superior lumbar triangle, while the latter are defects of the inferior lumbar triangle. Primary lumbar hernias are further subdivided into congenital or acquired hernias and can further be classified as either primary or secondary. Secondary hernias occur after previous flank surgeries, iatrogenic muscular disruption, infection, or trauma. We review a rare presentation of metachronous symptomatic bilateral secondary acquired lumbar hernia following spine surgery. A successful laparoscopic transabdominal lumbar hernia repair with extraperitoneal mesh placement was performed, with resolution of the hernia symptoms. An extensive literature review regarding lumbar hernia and different types of repairs was performed.
1. Introduction
Lumbar hernias are a very rare abdominal wall defect [1]. Fewer than 400 cases have been reported in the literature and account for 2% of all abdominal wall hernias [2, 3]. Lumbar hernias can be categorized by location and etiology into the Grynfelt-Lesshaft and Petit hernias. Grynfelt-Lesshaft are hernia defects through the superior lumbar triangle, defined as the area between the internal oblique, quadratus lumborum, the 12th rib and serratus posterior, external oblique and latissimus muscle, and the transversus abdominis aponeurosis [4]. Petit hernias are defects of the inferior lumbar triangle, defined as the area between the external oblique muscle, latissimus dorsi muscle, iliac crest, superficial fascia, and the internal oblique [5, 6] (Figure 1). The larger surface area size of the superior triangle compared to the inferior triangle is believed to be the reason why Grynfelt-Lesshaft hernias are much more common than Petit hernias [7].
... Acquired lumbar hernias are the result of iliac crest bone harvest or blunt trauma and seat belt injuries in [4] road accidents. Lumbar hernias are rare defects involving two weak areas of the posterolateral abdominal wall, the superior lumbar triangle of Grynfeltt, which is the most common site and the [5,6,7] inferior lumbar triangle of Petit . They represent a challenging problem to reconstructive surgeons. ...
... In cases where the clinical presentation suggesting strangulation, a diagnostic laparoscopy can be performed. [54][55][56][57][58][59][60] Surgery is the only treatment of LH and it should be performed early to prevent complications. The selection of the operative technique for LH should be based on the size of the hernia defect, location, contents, etiology, possibility of recurrence and availability of facilities, and expertise in the hospital. ...
... Since the nineties of the 20 th century, laparoscopy was introduced for repairing LHs. [57][58][59][60][61] Comparison between open versus laparoscopic repair of LH revealed that there is statistically significant lower morbidity rates, shorter length of hospital stay, reduced postoperative pain, and less required analgesia and earlier return to normal activity and work in favor of laparoscopic repair. However, using synthetic mesh directly with contact with the peritoneal content leads to fistula formation and intestinal obstruction, this can be avoided either by preperitoneal insertion of mesh or using biosynthetic mesh. ...
... Open procedures for repairing LH should be reserved for very small hernial defects and for patient with very large defect and for those who failed laparoscopic approach. [57][58][59][60][61] The aim of this review was to draw attention to the less common primary VAHs, for those who need to acquire the knowledge about the topic, namely, under-and post-graduate medical students, surgical trainees, and junior surgeons in practice. The secondary ventral hernia (IH) was reviewed in two previous articles published in this journal. ...
... Repair options include an open primary tissue repair, open mesh repair, or a laparoscopic repair. Defects cephalad to the iliac crest can be repaired using a ventral incisional hernia repair technique [5]. Laparoscopic mesh repair is a good option, as it allows for a tension-free repair, and spares the patient a longer incision, more pain and a longer hospital stay versus an open repair [1,4]. ...
Lateral ventral wall hernias have been sparsely reported on in the English literature. They are rare and can be incisional, traumatic, spontaneous, or congenital. The vast majority are traumatic or iatrogenic. The traumatic lateral ventral wall hernias reported to date have concentrated solely on blunt force trauma, secondary to a motor vehicle collision. In this case report, we describe the laparoscopic mesh repair of a traumatic lateral wall hernia in a 51 year old stab victim, who presented in a delayed fashion a year after his initial stabbing. To our knowledge, this represents the first case report of a laparoscopic lateral ventral wall herniorrhaphy secondary to a penetrating trauma. Regardless of the aetiology, these defects are complex to repair and have a high recurrence rate, due partly to the lack of redundant fascia and the inability to effectively mobilize multiple the muscle layers of the abdominal wall. Repair options include an open primary tissue repair, open mesh repair, or laparoscopic repair. Case reports of open repairs demonstrate great complexity, requiring large incisions with high morbidity and recurrence rates. Given the paucity of available literature, there is currently no consensus regarding the optimal repair. Laparoscopic mesh repair allows for a tension-free repair, and spares the patient a large incision and a longer hospital stay versus open herniorrhaphy.
... Another open mesh placement technique involved insertion within the musculoaponeurotic layers, e.g., between the external and the internal oblique layers [18,23,25]. For the laparoscopic approach, IPOM [2,57,63,64] is commonly employed, but preperitoneal placement of mesh through a transperitoneal approach also has been described for lumbar hernia [65,66]. Anecdotally, the senior author has seen two patients with early recurrence after primary IPOM repair of flank hernia; open retromuscular/preperitoneal mesh repair was accomplished in both patients with good results. ...
Purpose:
To review the published data describing the incidence, etiology, management, and outcomes of flank hernia.
Methods:
A retrospective review of articles identified with an online search (using the terms "flank hernia", "flank bulge", "lateral hernia", "retroperitoneal aorta hernia", and "open radical nephrectomy") was performed. Studies exclusively on lumbar hernia or subcostal hernia were excluded.
Results:
All articles retained for analysis (N = 26) were uncontrolled series or case reports; there were no controlled trials. The incidence of incisional hernia in the flank was ~ 17% (total patients analyzed = 1,061). Flank hernia repair was accomplished successfully with a variety of techniques, with overall mean rates of perioperative complications, chronic post-procedure pain, and recurrence equal to 20, 11, and 7%, respectively. Mesh utilization was universal.
Conclusions:
The available data of outcomes of flank hernia repair are not of high quality, and recommendations essentially consist of expert opinions. Operative approach (open vs. laparoscopic) and mesh insertion details have varied, but reasonable results appear possible with a number of techniques.
... 15,16 In turn, acquired lower lumbar hernias are divisible into primary and secondary types, the former resulting from an excessive tonus of abdominal musculature, e.g., in obese elderly people, and the latter being a consequence of damage to the abdominal muscles and resulting in scar formation. [16][17][18] In adults, lower lumbar hernias affect men 3 times more often than women, especially those aged 40-60 years, and with a greater tendency to occur on the right side. 15,[19][20][21][22] The main symptom reported by patients is a pain or discomfort in the lumbar region, usually when tightening the abdominal musculature. ...
Background:
The inferior lumbar triangle of Petit is bounded by the iliac crest, lateral border of the latissimus dorsi and the medial border of the external oblique.
Objectives:
In the present study, we aimed to quantitatively examine the base, sides, area, and interior angles of the inferior lumbar triangle in the human fetus so as to provide their growth dynamics.
Material and methods:
Using anatomical dissection, digital image analysis (NIS-Elements AR 3.0), and statistics (Student's t-test, regression analysis), we measured the base, 2 sides, area and interior angles of Petit's triangle in 35 fetuses of both sexes (16 male, 19 female) aged 14-24 weeks.
Results:
Neither sex nor laterality differences were found. All the parameters studied increased commensurately with age. The linear functions were computed as follows: y = -0.427 + 0.302 × age for base, y = 1.386 + 0.278 × age for medial side, y = 0.871 + 0.323 × age for lateral side, and y = -13.230 + 1.590 × age for area of the Petit triangle.
Conclusions:
In terms of geometry, Petit triangle reveals neither male-female nor right-left differences. An increase in both lengths and area of the inferior lumbar triangle follows proportionately. The Petit triangle is an acute one in the human fetus.
... Primary repair is challenging due to inadequate fascia around the defect making tensionless repair difficult [20]. Various primary repair [21], tissue flaps [9,17,22,23] and mesh repairs (including laparoscopic trans abdominal [3,[24][25][26][27] and retroperitoneoscopic approaches [19,[28][29][30] had been described. In view of the high failure rates observed in primary repair with facial closure, the principle of tensionless repair by the use of prosthesis became more popular in Lumbar hernia repairs. ...
... Three hundred cases have been reported to date in the current literature. [1] Although many surgical techniques have been proposed for the management of these types of hernias, none of them has been recommended as the gold standard method. Because of its rarity, there has been difficulty in defining the margins of the defect, the presence of a bone limits operative maneuvers, concomitant paralysis of the muscles is a complicating factor, and there is a lack of sufficient experience among surgeons. ...
... Lumbar hernia can be seen after laparoscopic and open nephrectomies, repair of abdominal aorta aneurysm and giant abdominal wall mass excision. [1] An interesting acquired lumbar hernia is believed to be from a case of herpes zoster exacerbation that resolved after resolution of the herpetic lesions. [6] The management of lumbar hernia is controversial. ...
... In cases where the clinical presentation suggesting strangulation, a diagnostic laparoscopy can be performed. [54][55][56][57][58][59][60] Surgery is the only treatment of LH and it should be performed early to prevent complications. The selection of the operative technique for LH should be based on the size of the hernia defect, location, contents, etiology, possibility of recurrence and availability of facilities, and expertise in the hospital. ...
... Since the nineties of the 20 th century, laparoscopy was introduced for repairing LHs. [57][58][59][60][61] Comparison between open versus laparoscopic repair of LH revealed that there is statistically significant lower morbidity rates, shorter length of hospital stay, reduced postoperative pain, and less required analgesia and earlier return to normal activity and work in favor of laparoscopic repair. However, using synthetic mesh directly with contact with the peritoneal content leads to fistula formation and intestinal obstruction, this can be avoided either by preperitoneal insertion of mesh or using biosynthetic mesh. ...
... Open procedures for repairing LH should be reserved for very small hernial defects and for patient with very large defect and for those who failed laparoscopic approach. [57][58][59][60][61] The aim of this review was to draw attention to the less common primary VAHs, for those who need to acquire the knowledge about the topic, namely, under-and post-graduate medical students, surgical trainees, and junior surgeons in practice. The secondary ventral hernia (IH) was reviewed in two previous articles published in this journal. ...
