EP611 - Abdominal Lumbar Hernias in the Community Setting: A Case Series

Purpose/Background: Lumbar hernia encompassing both superior (Grynfeltt's) and inferior (Petit's) types, represent rare defects of the posterior abdominal wall. Literature review primarily consists of isolated case reports. Most are acquired, typically resulting from increased intra-abdominal pressure, trauma, or previous surgical interventions involving retroperitoneum such as transplant or vascular operations.

Methods/Interventions: This case series highlights two cases treated at our institution over a 10-year period. We aim to contribute to the understanding of nontraumatic abdominal lumbar hernias by comparing decision making, anatomical considerations, and outcomes of a laparoscopic versus open approach to surgical management.

Results/Outcomes: A 72-year-old male presented with swelling of his right abdomen. A CT scan revealed a large right lateral abdominal wall hernia through the inferior lumbar triangle containing mesenteric fat and non-obstructed loops of small bowel. A laparoscopic approach was chosen for repair of the right inferior lumbar hernia. A supraumbilical 12 mm port was placed for entry followed by 12 mm left upper abdominal port and a 5 mm port in the left lower abdomen. An incision was made in the peritoneum 5 cm superior to the fascial edge and hernia sac was dissected out. The defect was visualized superior to the iliac crest. A right inguinal hernia was also visualized. A 15 cm mesh was used to cover both the lumbar and inguinal defects secured in place with absorbable tacks. The patient was discharged home with no recorded recurrence on follow up. A seroma was noted which resolved in 4 months with conservative management.

A 77-year-old female presented to the office for evaluation of a left flank lump that was growing in size, causing her discomfort. Ultrasound was performed with findings of a fat containing posterior lumbar hernia. She underwent an open left lumbar hernia repair. An oblique incision was made on top of the hernia and dissection was carried through skin and subcutaneous tissue until a small bulge was identified underneath the 12th rib. Hernia content was dissected out and pushed back down through the hernia defect. The defect measured 1x2 cm and was closed primarily with interrupted PDS sutures. Latissimus dorsi was also approximated overtop to close the defect. The incision was then closed in two layers, followed by skin closure. She was discharged home on the same day. Her perioperative course was complicated by neuropathic pain that resolved with medical management within 2 months. No recurrence was noted.

Conclusion/Discussion: At a high-volume hernia center, flank and lumbar hernias were studied in retrospective review, with a total of 142 combined lateral hernias reported within an 18-year period, with only 36 presenting as lumbar hernias (Salvino et al, 2024). Lumbar hernias can be difficult to repair particularly due to their location, often abutting bony structures and extending posteriorly, requiring mesh to be placed in a curved space. A variety of surgical approaches have been reported including open and minimally invasive techniques with varying mesh placement including onlay and inlay placements (Chen, Fan, Zhou, 2023). Attempts to identify the preferred repair technique as well as rate of recurrence have been limited due to its rare presentation. In this case series, we report two instances of identified lumbar hernias in the community setting that underwent two alternative methods of repair.