title: Anatomical and surgical considerations on lumbar hernias.
abstract: Lumbar hernias, which are rare hernias of the posterolateral abdominal wall, can be divided into two groups: primary lumbar hernias, often the expression of a congenital defect, which typically arise in two areas of weakness, the superior triangle and inferior triangle and acquired (or diffuse) lumbar hernias which are usually due to previous lumbar trauma or surgery. Clinical examination may be adjuvated by ultrasound or CT scan, which can reveal the abdominal wall defect with the hernia content (viscera or extraperitoneal tissue). Surgical repair of lumbar hernias, both primary and acquired, has rapidly developed through recent years, similarly to the treatment of more frequent kinds of hernia (groin, epigastric), evolving from direct repair to mini-invasive techniques, even if, since the rarity of these hernias, precise knowledge of this complex anatomic region is required. Nowadays there are two valid alternatives: open tension-free repair (with use of mesh), and mini-invasive repair. Both are safe and effective, even if smaller hernias can be treated by open approach, with loco-regional anesthesia and good cosmetic effect. Larger hernias, or hernias with suspected viscera involvement, should require larger incisions and viscera exploration. For this reason laparoscopic access would be preferable.
authors.affiliation: Department of Surgery, P. Valdoni, Policlinico Umberto I, Sapienza University, Rome, Italy. giuseppe.cavallaro@uniroma1.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Cavallaro
authors.forename: Arash
authors.initials: A
authors.lastname: Sadighi
authors.forename: Claudia
authors.initials: C
authors.lastname: Paparelli
authors.forename: Mario
authors.initials: M
authors.lastname: Miceli
authors.forename: Giuseppe
authors.initials: G
authors.lastname: D'Ermo
authors.forename: Andrea
authors.initials: A
authors.lastname: Polistena
authors.forename: Antonino
authors.initials: A
authors.lastname: Cavallaro
authors.forename: Giorgio
authors.initials: G
authors.lastname: De Toma
mesh_terms: D006555:Hernia, Ventral / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D019060:Minimally Invasive Surgical Procedures; D013526:Surgical Mesh