Lumbar hernia is a rare defect of the abdominal wall. It accounts for 2 % of all wall hernias. It is divided in two levels: superior lumbar hernia, also known as Grynfeltt's hernia (GH), and an inferior lumbar hernia or Petit's hernia. GH is more commonly encountered in practice, and it is mainly posttraumatic in origin. Spontaneous primary GH is quite rare. Only 250 to 300 of such cases have been reported the in literature so far. The treatment of choice is retroperitoneal surgical approach and a meshplasty after complete reduction of its contents. Prognosis is usually excellent.

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a p o l l o m e d i c i n e 1 2 s ( 2 0 1 5 ) S10-S29 S13during perianal surgeries in two, acute obstetric injury in two and postpartum delayed fistula in the remaining two. MRI pelvis was done in all these patients prior to surgery. Amongst these, two patients already had a diversion stoma at time of referral. Patient outcomes were assessed after surgical repair as the percentage of patients with a healed fistula after a median follow-up of 6 months.Results: All 6 patients had complete fistula closure with no recurrence. However, 2 patients had complications in the postoperative period. In one, there was partial necrosis of gracilis flap needing debridement but fistula healed completely in 3 months. The second patient had superficial wound infection, which was dealt with conservatively.Conclusion: Gracilis muscle interposition is an excellent option for patients with complex perianal fistula with minimal morbidity and high success rate.

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