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DOI: 10.1055/s-0032-1308705
Laparoscopic Repair of an Isolated Congenital Bilateral Lumbar Hernia in an Infant
Publication History
02 November 2011
08 December 2011
Publication Date:
10 May 2012 (online)
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We describe the laparoscopic repair of an isolated congenital bilateral lumbar hernia in an infant. Initial laparoscopic primary repair with nonabsorbable interrupted sutures resulted in recurrence, but subsequent laparoscopic mesh repair led to satisfying results.
A lumbar hernia is defined as the protrusion of an organ or tissue through a defect in the posterolateral abdominal wall. This type of hernia is extremely rare. In 1774, Petit reported a patient with a strangulated lumbar hernia. He also described the anatomical borders of the (inferior) lumbar triangle through which the hernia protruded.[1] Although he was not the first to publish on this subject, the inferior triangle and the associated hernia are nowadays associated with Petit. Nearly a century later, in 1866, the existence of a superior lumbar triangle was reported by Grynfeltt.[2]
The inferior lumbar triangle (Petit) is an upright triangular space. Its boundaries are the posterior border of the external oblique muscle anteriorly, the anterior border of the latissimus dorsi muscle posteriorly and the iliac crest inferiorly. Its roof is the superficial fascia and its floor the internal oblique muscle. The superior lumbar triangle (Grynfeltt) is an inverted triangular space. Its borders consist of the posterior border of the internal oblique muscle anteriorly, the anterior border of the sacrospinalis muscle posteriorly, and the 12th rib and serratus posterior inferior muscle superiorly. The roof is formed by the latissimus dorsi muscle and the floor by the aponeurosis of the transversus abdominis muscle.[3]
In 2007, Moreno-Egea et al estimated that 300 cases of lumbar hernia, protruding through the inferior or superior lumbar triangles, have been reported in the medical literature.[4] Approximately 80% of these hernias are considered to be acquired (i.e., incisional or postinfectious) while 20% are thought to be congenital.[5] Consistent with these findings, in 2008, Akçora et al reported that a total of 60 congenital hernias have been described.[6] In 20 cases, the congenital hernias were associated with the lumbocostovertebral syndrome.[7] [8] [9] This syndrome includes hemivertebrae, absence of ribs, anterior myelomeningocele, and abdominal wall muscular hypoplasia. Other abnormalities associated with congenital lumbar hernia have been described as well. However, no additional anomalies were found in our patient.
Isolated bilateral congenital hernia and open repair in an infant have been described before for the first and, to our knowledge, only time in 2002.[10] Here, we report for the first time the laparoscopic repair of this type of bilateral hernia in a baby.
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References
- 1 Petit JL. Traite des Maladies Chirurgicales, et des Operations Qui Leur Convennient. 2nd ed. Paris, France: TF Ditot; 1774: 256-259
- 2 Grynfeltt J. Quelque Mots sur la hernie lombaire. 16th ed. Montpellier, France: Med; 1866: 323
- 3 Stamatiou D, Skandalakis JE, Skandalakis LJ, Mirilas P. Lumbar hernia: surgical anatomy, embryology, and technique of repair. Am Surg 2009; 75 (3) 202-207
- 4 Moreno-Egea A, Baena EG, Calle MC, Martínez JA, Albasini JL. Controversies in the current management of lumbar hernias. Arch Surg 2007; 142 (1) 82-88
- 5 Geis WP, Saletta JD. Lumbar hernia. In: Nyhus LM, Condon RE, eds. Hernia. 3rd ed. Philadelphia: JB Lippincott; 1989: 401-415
- 6 Akçora B, Temiz A, Babayiğit C. A different type of congenital lumbar hernia associated with the lumbocostovertebral syndrome. J Pediatr Surg 2008; 43 (1) e21-e23
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- 8 Hancock BJ, Wiseman NE. Incarcerated congenital lumbar hernia associated with the lumbocostovertebral syndrome. J Pediatr Surg 1988; 23 (8) 782-783
- 9 Touloukian RJ. The lymbocostovertebral syndrome: a single somatic defect. Surgery 1972; 71 (2) 174-181
- 10 Karmani S, Ember T, Davenport R. Congenital lumbar hernias: a case report. J Pediatr Surg 2002; 37 (6) 921-922
- 11 Cavallaro G, Sadighi A, Paparelli C , et al. Anatomical and surgical considerations on lumbar hernias. Am Surg 2009; 75 (12) 1238-1241
- 12 Jones SL, Thomas I, Hamill J. Laparoscopic lumbar hernia repair in a child with lumbocostovertebral syndrome. J Laparoendosc Adv Surg Tech A 2010; 20 (1) 97-98