1227 Laparoscopic Repair of a Grynfeltt-Lesshaft Hernia: Case Report
M Quaunine, A Wilkins, D Mitton, A Myatt- Surgery
Abstract
Background
Lumbar hernias are an uncommon presentation, with only 300 cases published to date. The aetiology is variable, and they usually present as palpable masses or swellings in the lumbar region. We present a case of successful laparoscopic transabdominal preperitoneal (TAPP) repair of a lumbar hernia with mesh.
Case report
A 62-year-old male patient, with a history of sarcoidosis and hypertension, was referred to general surgeons with a symptomatic enlarging swelling in the left lumbar region. Preoperative computed tomography (CT) and Ultrasound revealed a superior lumbar hernia. Intraoperatively a 2cm defect was identified. A small lipoma was present within the defect and excised. The defect was repaired with a 10x15cm SymbotexTM mesh secured with ProtackTM. There were no complications operatively or post-operatively and he was discharged the following day.
Discussion
Anatomically, the lumbar region is bound by the 12th rib superiorly, the iliac crest inferiorly, erector spinae muscles medially and external oblique laterally. Two defined areas of weakness are the superior (Grynfeltt-Lesshaft’s) and inferior (Petit’s) triangles, the first being more common for hernias and experienced by our patient. Surgical repair is the only definitive management and is recommended due to the significant risk of complications. A therapeutically aimed classification system, such as Mereno-Ageas, can be utilised to decide between open and laparoscopic approaches.
Conclusions
Lumbar hernias are often misdiagnosed due to their rarity. An in-depth history, clinical examination and use of CT preoperatively will aid diagnosis and guide management. Ultimately management will depend on the individual patient and clinician preferences and experience.