Background Abdominal wall surgery has changed dramatically in recent years. The current management of lumbar hernias should reflect the development of modern imaging techniques and new forms of noninvasive treatment. Objective To review and update knowledge on lumbar hernias. Data Sources Literature review using MEDLINE with the key words “lumbar hernia” for the years 1950 through 2004. For an analysis prior to this date (1750-1950), we used cases reported by Thorek. Our own study of 28 patients was also included. Study Selection All articles reporting clinical cases on lumbar hernia. Data Extraction Two reviewers analyzed the epidemiological, clinical, and treatment data of the articles. Data Synthesis One hundred thirty-five clinical case articles and 8 studies with more than 5 patients, together with our personal experience of 28 cases, were analyzed. Nine percent of acquired lumbar hernia cases presented for emergency surgery, which means that a clinical diagnosis was completed with computed tomography in more than 90% of the cases. None of the published classifications has a therapeutic orientation. We present an original classification based on 6 categories and 4 types. In our study, there was a predominance of incisional hernias (79%), with no difference with regard to sex or location but with a predominance in the upper space (47%). Laparoscopic treatment accounts for 9% of the publications' cases and there is only 1 prospective comparative study. Conclusions The use of a complete classification and tomography must be standard practice in the preoperative protocol of patients with lumbar hernia. The laparoscopic approach seems to be the best option for treating small or moderate defects; open surgery can be reserved for large defects and to salvage failures with the laparoscopic approach.

https://jamanetwork.com/journals/jamasurgery/articlepdf/399652/srv50015_82_88.pdf

Controversies in the current management of lumbar hernias.

Background:Acute lumbar hernia secondary to blunt trauma is an uncommon injury of the abdominal wall and, when encountered, is a difficult challenge for the trauma surgeon.Methods:Three cases of lumbar hernia secondary to blunt trauma are described and a review of the literature was conducted for ot

Traumatic lumbar hernia: report of cases and comprehensive review of the literature.

Introduction Lumbar hernias occur infrequently and can be congenital, primary (inferior or Petit type, and superior or Grynfeltt type), posttraumatic, or incisional. They are bounded by the 12th rib, the iliac crest, the erector spinae, and the external oblique muscle. Most postoperative incisional hernias occur in nephrectomy or aortic aneurysm repair incisions. Case report We present 2 patients who had undergone flank incisions and subsequently developed significant bulging of that area. The first patient had an atrophy of the abdominal wall musculature while the other had a large lumbar incisional hernia that was repaired laparoscopically. Discussion Lumbar incisional hernias are often diffuse with fascial defects that are usually hard to appreciate. Computed tomography scan is the diagnostic modality of choice and allows differentiating them from abdominal wall musculature denervation atrophy complicating flank incisions. Repairing these hernias is difficult due to the surrounding structures. Principles of laparoscopic repair include lateral decubitus positioning with table flexed, adhesiolysis, and reduction of hernia contents, securing ePTFE mesh with spiral tacks and transfascial sutures to an intercostal space superiorly, iliac crest periosteum inferiorly, and rectus muscle anteriorly. Posteriorly, the mesh is secured to psoas major fascia with intracorporeal sutures to avoid nerve injury. Conclusion Lumbar incisional hernia must be differentiated from muscle atrophy with no fascial defect. The laparoscopic approach provides an attractive option for this often challenging problem.

Lumbar incisional hernias: diagnostic and management dilemma.

terms: ‘haemangiopericytoma and kidney’, ‘renal haemangiopericytoma’, in any language available, in all Document types. All cases of a renal origin were recorded, and the data extracted were: age, sex, symptoms at presentation, the size and weight of the tumours, the therapeutic methods used, and the outcome of each patient. When the article was not available the abstracts served as a source of information.

Renal haemangiopericytoma: the characteristics of a rare tumour.

Inferior lumbar triangle hernia as a rarely reported cause of low back pain: a report of 4 cases

A lumbar hernia which had developed following blunt abdominopelvic trauma is described here. The successful surgical correction is reported.

Post traumatic lumbar hernia.

The diagnosis and management of a thirty year old male with a hemangiopericytoma of the kidney is reported.

AA Mavanur

Papers

Post traumatic lumbar hernia.

Hemangiopericytoma of the kidney.