Laparoscopic Repair of Unusual Hernias: lumbar, spigelian and other special hernias

Abstract

Lumbar hernias are rare defects, with approximately 300 cases reported since the first suggestion of their existence (1). Anatomically, the defect involves the extrusion of retroperitoneal fat or viscera through a weakness in the posterior abdominal wall. There are two distinct sites through which lumbar herniation has been described. Petit first, in 1738 (2), described the anatomy of the inferior lumbar triangle: the lateral border of the latissimus dorsi muscle, the posterior margin of the external oblique muscle, and the superior aspect of the iliac crest. The superior lumbar triangle was described by Grynfeltt (3). It is an inverted triangle bound by the internal oblique muscles anteriorly, the erector spinae muscle group medially, and the 12^th rib superiorly. Although lumbar hernias may arise in either or both of these anatomic triangles, they are found most frequently on the left side and in the superior triangle (4). Two thirds have been documented in men (5).