Lumbar Hernia
Lumbar hernias are weaknesses in the posterolateral abdominal wall occuring between the costo-iliac spaces.
They are more common in men aged 50-70 and more common on the left side.
They can contain omentum, bowel or pre-peritoneal fat. However, any intrabdominal organ can be involved.
Petit’s triangle borders (Inferior triangle) : anterior border of external oblique, posterior border of lattissimus dorsi and inferior border of the iliac crest.
Grynfeltt-Lesshaft triangle borders (superior triangle): laterally by inferior oblique muscle, floor of the transversalis fascia, medial border of the quadratus lamborum and superiorly by the 12th rib. (hernias more likely to occur in this triangle)
Causes can be categorised as congenital, acquired, traumatic or iatrogenic (eg. hip arthroplasty, nephrectomies, flap for breast reconstruction).
Most are due to trauma or surgical interventions
How do you repair it?
Open: incision over swelling, dissect the sac in pre-peritoneal fat, define the edges, reduce the sac after checking contents and place a non-absorbable mesh in the pre-peritoneal space. Secure it to the muscles and if possible close the space with the muscle flaps over the mesh.
Laparoscopic can be transabdominal or extra-peritoneal. In the transabdominal access, the colon has to be mobilised and a 5cm overlap has to be created.