Lumbar Hernia: A Report of a Unique Case and Review of the Literature

We present a case of a 53-year-old female with a left-sided superior lumbar hernia who underwent successful laparoscopic reduction and mesh repair. The case report is accompanied by an extensive literature review of lumbar hernias. The review's purpose is to provide details of what can be expected when treating this rare defect. Publications relevant to the reporting of lumbar hernias were found using the National Library of Medicine database. Each case report was cataloged and reviewed. Repair type (open vs. laparoscopic), patient age, gender, presenting symptoms, complications, hernia site, length of hospital stay, and trauma/surgical history were recorded in a spreadsheet. Of the 41 patients, 11 had complications following hernia repair, the most common being recurrence, which occurred in seven patients. Of the 11 patients who reported complications, four had an open procedure, and eight had a laparoscopy (one patient underwent both open and laparoscopic surgery and had complications after both procedures). In two of the seven cases of recurrence (28.5%), an open surgical approach was used for the revision surgery, where the initial repair had been attempted laparoscopically. Our review found that the most common causes of traumatic injury in patients who went on to develop a lumbar hernia were motor vehicle accidents (29.2%) or a bone graft taken from the iliac crest (14.6%). Our review also found that the patient in our case had a unique surgical history (abdominoplasty, breast implants, implant removal) amongst lumbar hernia patients. Our literature review provides a clinical picture of the presentation of a lumbar hernia patient with a unique surgical history, as well as the most statistically relevant history. It can be speculated that our patient's unique surgical history may have contributed to the development of a lumbar hernia, although it cannot be deemed causation due to it being a unique case. While lumbar hernias are an extremely rare occurrence, they should be considered in patients with a mass accompanied by flank pain, especially in patients with a history of trauma or iliac crest bone grafting. Laparoscopic repair appears to offer a shorter hospital stay, but recurrence remains a notable complication, possibly due to the unique nature of lumbar hernias and surgeons' inexperience in treating them. When deciding on treatment, the surgeon should take into account the site of the hernia and their experience in laparoscopic hernia repair, and ultimately make the decision together with the patient.