Primary lumbar hernia: A rare case report and a review of the literature

Abstract

Primary lumbar hernia is a rarely encountered hernia. Surgical correction is the standard treatment for lumbar hernia, and either an open or laparoscopic procedure can be performed with equivalent success. However, open repairs are most commonly performed. Here, we present a case of a primary lumbar hernia that was successfully treated laparoscopically and discuss surgical modalities of treatment reported in the literature. There are two laparoscopic approaches: transabdominal and extraperitoneal. The main advantage of the laparoscopic approach is that it helps the surgeon to precisely locate and evaluate the characteristics of the defect. It also has a lower morbidity rate, shorter length of hospital stay, less postoperative pain, and an earlier return to daily routine activities than the open approach. In the present study, a patient with a superior lumbar hernia was treated laparoscopically by the transabdominal approach. Laparoscopic repair in such cases is feasible and achieves a good result when done by an experienced laparoscopic hernia surgeon.

<p>Primary superior lumbar hernia፡ a rare cause of lumbar swelling</p>

“…In the current case report, the patient underwent open surgery and the defect was repaired using an underlay prolene mesh. A similar technique has been reported by Sharma and Bhati17 and Ankush et al13 Even though the patient stayed for four days in the hospital and was followed-up for four months as an outpatient, finally, a good result was achieved. Therefore, an appropriate surgical treatment which shortens the length of hospital stay, lower consumption of analgesics, earlier return to normal activity, and less chance of wound infection should be planned.…”

“…Surgery is typically recommended to repair the defect and prevent complications 12. Either an open or laparoscopic procedure can be performed with equivalent success 13. However, the choice of the operative technique depends on the experience of the surgeon and the diameter of the hernia size 1.…”

Lumbar hernia diagnosed after laparoscopic hiatal hernia surgery

“…2,3 F I G U R E 1 Transverse slice of CT abdomen showing ascending colon in hernial sac F I G U R E 2 Coronal slice of CT abdomen showing area of hernia relative to 12th rib and iliac crest 20% of lumbar hernias are congenital, and the remaining 80% are primary (spontaneous) or secondary (acquired). 5 Risk factors include conditions that elevate intra-abdominal pressure as well as aging, muscle atrophy, and extreme loss of fatty tissue. 4 Secondary lumbar hernias can occur due to trauma, infection, or postoperative complications.…”

“…They most commonly present as a posterolateral mass that is usually reducible increasing with a rise in intra-abdominal pressure and reducing when the patient assumes the prone position. 5 Approximately, 9% of patients presenting with lumbar hernia have associated bowel obstruction. 4 Low suspicion can lead to misdiagnosis of other pathologies such as lipomas or retroperitoneal tumors.…”

“…20% of lumbar hernias are congenital, and the remaining 80% are primary (spontaneous) or secondary (acquired) 5 . Risk factors include conditions that elevate intra‐abdominal pressure as well as aging, muscle atrophy, and extreme loss of fatty tissue 4 .…”