Repair of lumbar hernia originating from autogenous iliac bone graft with bilayer mesh

Abstract

KEYWORDS lumbar hernias; lumbar incisional hernia; surgical repair Summary A 60-year-old female patient, who had previously undergone an iliac bone graft harvest, was diagnosed with the aid of an abdominal CT scan to have an inferior lumbar hernia, complicated with bowel incarceration. Reduction of the protruding sac was performed. The weak point of the inferior lumbar hernia was reinforced by hernioplasty with a bilayer mesh. No evidence of recurrence was noted 16 months after surgery. The iliac bone graft is often adopted for various purposes by orthopedists and neurosurgeons, which may contribute to an unusual lumbar hernia. The purpose of this communication is to emphasize the possibility of complications following such surgical procedures and to provide useful information, including radiographic images and photographs of this extraordinary type of hernia. Hernioplasty with a bilayer mesh is safe, effective and convenient, in spite of a variety of commercially available meshes.

Iliolumbar incisional hernia following iliac bone harvesting: a rare complication

“…This area is divided into two compartments: superior (Grynfeltt hernia) and inferior triangle (Petit hernia). 3 The superior lumbar triangle is bordered superiorly by the twelfth rib, the lumbocostal ligament, and the serratus posterior inferior muscle, laterally by the internal oblique muscle, and medially by the erector spinae muscle. The inferior lumbar triangle includes the iliac crest inferior, the external oblique muscle laterally, and the latissimus dorsi muscle medially.…”

“…A CT scan is commonly used to confirm the diagnosis, and also to delineate the anatomy. 3 Repairing such hernias can be done by patching up the soft tissue, or by reinforcing the soft tissue with fascial flaps, bone transfer or mesh. The tension-free mesh repair can be performed with a laparoscopic, retroperitoneal or transabdominal approach.…”

“…Another technique of soft tissue transfer involves using the transversalis fascia, abdominal musculature, and tensor fascia lata. Alternatively, the anterior superior iliac spine can be moved inferiorly and posteriorly to cover the defect in the iliac bone 3 . We chose to repair the hernia of the iliac crest defect using an extraperitoneal approach with an onlay mesh.…”

Herniation from Right Iliac Crest Secondary to Autogenous Bone Grafting: A Rare Case Presentation

“…superior traingle (Grynfeltt hernia) and inferior triangle (Petit hernia). 7 The superior lumbar triangle is bordered superiorly by the twelfth rib, medially by quadrates lumborum muscle and laterally by the internal oblique muscle. The inferior lumbar triangle, is bounded by the latissimus dorsi posteriorly, the external oblique anteriorly, and the iliac crest inferiorly, which is the base of the triangle.…”

“…Alternatively the anterior superior iliac spine can be moved inferiorly and posteriorly to cover the defect in the iliac bone. 7 We chose to repair the hernia of the iliac crest defect using an extraperitoneal approach with an onlay mesh.…”