Sandwich technique of closure of lumbar hernia: A novel technique

Lumbar hernia is a rare hernia which accounts for less than 1.5% of total hernia incidence. Only about 300 cases have been reported in literature. Lumbar hernia herniates through the superior or inferior lumbar triangle. Herniation through inferior triangle is more common, probably due to variable attachment of external oblique and latissimus dorsi to iliac crest. If they are closely attached then this triangle is not present and no hernia occurs. We present our experience of four cases of lumbar hernias over a period of two years. All patients presented with gradually enlarging swelling in the loin which enlarged in size on coughing and straining. Two of them presented with multiple small ulceration over the swelling. Examination revealed swelling in the lumbar region with positive cough impulse, incomplete reducibility, and bowel sounds on auscultation. Ultrasound and computed tomography (CT) scan revealed hernia in right lumbar region in all cases. Transverse skin incision was given over the hernia. After dissection in layers, the sac was separated and contents were reduced. Around 15x15 cm prolene mesh was placed extraperitoneally and fixed around the defect. Another overlay of 15x15 cm prolene mesh was placed, thus sandwiching prolene mesh in between layers of abdomen. Negative suction drain was given in all cases. 10 months of mean follow-up revealed no recurrence. Sandwich technique of closure of lumbar hernias is safe, feasible, acceptable and associated with no short-term recurrence rates. However, long-term follow-up is needed to prove the efficacy of this technique.