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Congenital lumbar herniae: a systematic review
N Tasis1, I Tsouknidas2, M I Antonopoulou3
1Second Department of Surgery, Athens Naval and Veterans Hospital, Dinokratous 70, Kolonaki, Athens, Greece. tasisnikolaos@gmail.com.
Insights
Congenital lumbar hernia is a rare condition in children. Surgical repair is often recommended within the first year for optimal torso development, with low recurrence rates.
Area of Science:
- Pediatric Surgery
- Congenital Abnormalities
- Abdominal Wall Defects
Background:
- Congenital lumbar hernia involves visceral protrusion through the posterior abdominal wall present at birth.
- This systematic review focuses on surgical decision-making for this rare pediatric pathology.
Approach:
- A systematic review of English literature from 2000-2020 was conducted using PubMed, EMBASE, and Google Scholar.
- Data from 35 studies encompassing 85 pediatric patients with congenital lumbar hernia were analyzed.
Key Points:
- The majority of patients (83.3%) underwent surgical repair, predominantly open procedures (93.3%), with primary suture repair being common (71.7%).
- Associated anatomical anomalies were present in 71.8% of cases, highlighting the need for thorough investigation.
- Post-operative morbidity was low (6.7%), and the recurrence rate was 3.3% at a mean follow-up of 26.4 months.
Conclusions:
- Congenital lumbar hernia is rare in pediatrics, necessitating vigilance for associated anomalies.
- Surgical intervention, typically within the first year, is crucial for symmetrical torso development.
- The study emphasizes the importance of cross-sectional imaging for diagnosis and management planning.
Purpose:
Congenital lumbar hernia is defined as the protrusion of intraperitoneal or extraperitoneal viscera through a defect of the posterior abdominal wall, present at birth. The aim of our study was to perform a systematic review of this rare pathology, with emphasis on surgical decision-making.
Methods:
The English literature (2000-2020) was reviewed, using PubMed, EMBASE and GoogleScholar databases, combining the terms "hernia", "lumbar", "flank", "Grynfeltt", "Petit" and "congenital". Overall, 35 studies were included, describing 85 patients.
Results:
Mean age was 9.7 ± 20.7 months (range 1 day-10 years). 55.7% were males and 44.3% were females. All patients presented electively, with flank bulging as the main symptom. Superior lumbar triangle (Grynfeltt) herniae accounted for 41.8%, inferior lumbar triangle (Petit) herniae for 32.8%, whereas 25.4% were classified as diffuse. A left-sided hernia was observed in 47%, a right-sided in 42.4%, while 10.6% were bilateral. 71.8% of the patients had associated anatomical anomalies, mainly the lumbocostovertebral syndrome. Most patients (83.3%) were treated surgically, while 16.7% conservatively with surveillance. In 93.3%, the surgical approach was open, with laparoscopy employed in 6.7% of cases. The majority (71.7%) underwent primary suture repair of the hernia defect, whereas a mesh was required in 28.3%. Post-operative morbidity was 6.7% and recurrence rate was 3.3% at a mean follow-up of 26.4 months.
Conclusion:
Congenital lumbar hernia is a rare pathology in the paediatric population, with only 85 cases reported since 2000. Although the diagnosis is frequently straightforward, it should raise the suspicion for associated congenital anomalies and further investigation is required, with cross-sectional imaging. Surgical repair is usually performed during the first year, to allow for symmetrical torso development.
