Minimally Invasive Approach to Grynfelt Hernia (L4)

Aims Lumbar hernias are defects occurring in the posterolateral wall of the abdomen, at the level of the upper Grynfelt’s triangle and a lower triangle (Petit triangle). The minimally invasive approach provides advantages in comparison to the conventional approach and the possibility of placing a preperitoneal mesh, avoiding contact with bowel. Methods We present the case of a 28-year-old man with a history of urological intervention in childhood for congenital defects in both kidneys through bilateral lumbotomy. The patient complained of discomfort at the site of the lumbar hernia for a year. On examination, a soft, reducible lump was palpated in the left posterolateral region of the abdominal wall. Computed tomography scan confirmed the lumbar hernia through the upper Grynfelt’s triangle of 35 mm (hernia type L4, EHS). Results Patient underwent surgery by transabdominal laparoscopic approach, placing three trocars in left clavicular midline. Right parietocolic groove is opened and a peritoneum is dissected to access Grynfelt’s triangle. After the reduction of the hernial content (fatty tissue), direct closure of the hernial defect is performed with non-absorbable barbed suture and a tailored PVDF mesh is placed intraperitoneally. Then peritoneal flap is closed with absorbable barbed suture. Patient was discharged on first postoperative day. At one-year follow-up complications or recurrence did not occur. Conclusions Laparoscopic approach to lumbar hernias is feasible providing the advantages of minimally invasive surgery, and in addition the possibility to explore the entire abdominal cavity. More studies with larger numbers of patients are needed to draw definitive conclusions.