Open Mesh Repair of a Primary Grynfelt-Lesshaft Hernia: A Case Report and Literature Review

Grynfelt-Lesshaft hernias are extremely rare posterolateral abdominal wall defects, with a nonspecific clinical presentation that often leads to misdiagnosis or delayed recognition; hence, a high index of suspicion and proper imaging are necessary. A 71-year-old woman presented with a gradually increasing swelling over the left lumbar region for three months. On examination, there was a soft, reducible, nontender swelling in the left posterolateral lumbar region, which increased after performing Valsalva's maneuver. Ultrasound of the abdomen revealed a 4 cm defect in the left superior lumbar triangle with protruding retroperitoneal fat. A non-contrast-enhanced CT scan confirmed the presence of a primary Grynfelt-Lesshaft hernia containing retroperitoneal fat without any visceral involvement or incarceration. Open elective repair was performed via an 8 cm left subcostal incision with the patient positioned on their right side. The hernia sac was dissected, the herniated contents were reduced, and the defect was repaired with primary suture and a polypropylene mesh that was placed in a subaponeurotic plane and secured to the periosteum of the 12th rib, transversalis fascia, quadratus lumborum muscle, and internal oblique muscle. The patient had an uneventful postoperative course with adequate pain control and no wound-related complications. Clinical recovery was satisfactory at the one-year follow-up. Grynfelt-Lesshaft hernia is an entity that poses a challenge for diagnosis because of its rarity and variable clinical presentation. Computed tomography has remained the diagnostic modality of choice. It helps confirm the diagnosis of hernia, define its contents, and aid in planning the surgery. This case supports open tension-free mesh repair as a feasible option in appropriately selected primary superior lumbar hernias.