Bilateral Lumbar Hernias Following Spine Surgery: A Case Report and Laparoscopic Transabdominal Repair

Abstract

Lumbar hernias are rare abdominal wall defects. Fewer than 400 cases have been reported in the literature and account for 2% of all abdominal wall hernias. Lumbar hernias are divided into Grynfelt-Lesshaft or Petit hernias. The former are hernia defects through the superior lumbar triangle, while the latter are defects of the inferior lumbar triangle. Primary lumbar hernias are further subdivided into congenital or acquired hernias and can further be classified as either primary or secondary. Secondary hernias occur after previous flank surgeries, iatrogenic muscular disruption, infection, or trauma. We review a rare presentation of metachronous symptomatic bilateral secondary acquired lumbar hernia following spine surgery. A successful laparoscopic transabdominal lumbar hernia repair with extraperitoneal mesh placement was performed, with resolution of the hernia symptoms. An extensive literature review regarding lumbar hernia and different types of repairs was performed.

An Extremely Rare Case Report of a Retroperitoneal Hernia Following Spinal Surgery

“…Most of the iatrogenic retroperitoneal hernias described in the literature have been related to injury to the retroperitoneal fascia in renal transplant surgery [26], retroperitoneal nephrectomies [27], radical cystectomy [28], or obtaining bone graft from the iliac crest [29], among others. However, hardly any cases of retroperitoneal hernias have been reported in the context of spinal surgery, and most of them are incisional hernias associated with lateral approaches to the thoracolumbar spine [9], whose usual clinical presentation is a bulging mass at the their lateral incision site. Although some authors suggest that its true incidence may be underestimated [30], only twenty three cases of incisional hernias have been described as a consequence of a lateral approach to the spine [30][31][32][33][34][35].…”

“…Among the most frequent complications associated with this approach are excessive blood loss due to injury to vascular structures originating from subdermal vascular plexus, perforating segmental arteries, muscle, bone, and epidural venous plexus; surgical site infections, with has an estimated incidence of 1.0% to 12.0% [3]; epidural hematoma and its potentially devastating sequelae [4]; or wrong-level surgery, which prevalence has been estimated to be 1 in 3110 surgeries [5]. While hernias of the lumbar wall are a rare entity [6], and although spinal surgery has been described as a possible iatrogenic cause of them [7][8][9], however, there are no documented cases of retroperitoneal hernias secondary to a posterior approach of the lumbar spine.…”

Management of Massive Flank Hernia After Lateral Lumbar Fusion: Preoperative Botulinum Toxin Injections and Open Repair – A Case Report

“…The DLIF and XLIF approaches were developed to avoid performing spinal interbody fusion through the anterior approach, due to the risk of iatrogenic vascular injury [1], and they have been increasing in popularity because of expanding indications [2,3]. Six case reports and 1 retrospective study have been published on flank hernias after lateral interbody fusion procedures, totaling 21 flank hernia cases, making them extremely rare [4][5][6][7][8][9][10]. The National Institute for Health and Care Excellence (NICE) guidelines for lateral interbody fusion, based on a systematic review and meta-analysis of 237 articles, do not even mention flank hernias as one of the complications of lateral interbody fusion, demonstrating their rarity [11].…”

A Rare Case of Lumbar Hernia Secondary to an Iliopsoas Abscess: A Case Report

“…Lumbar hernias can be congenital (10-20%), arising from congenital muscle weakness, or acquired (80-90%), which can be spontaneous, also known as primary, or because of any preceding events such as trauma, infection, or postoperative, also known as secondary acquired hernia [2][3][4]. Lumbar hernias can be asymptomatic, presenting only as a flank mass or along with back or flank pain [5], or even severe pain if strangulation of the hernia has occurred.…”

“…Lumbar hernias can be asymptomatic, presenting only as a flank mass or along with back or flank pain [5], or even severe pain if strangulation of the hernia has occurred. Lumbar hernia is treated surgically, and both open and laparoscopic approaches have been described each with its own advantages and disadvantages [4].…”