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Hernia
Published in: Hernia 1/2019

Open Access 01-02-2019 | Review

Pitfalls and clinical recommendations for the primary lumbar hernia based on a systematic review of the literature

Authors: S. van Steensel, A. Bloemen, L. C. L. van den Hil, J. van den Bos, G. J. Kleinrensink, N. D. Bouvy

Published in: Hernia | Issue 1/2019

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Abstract

Purpose

The lumbar abdominal wall hernia is a rare hernia in which abdominal contents protrude through a defect in the dorsal abdominal wall, which can be of iatrogenic, congenital, or traumatic origin. Two anatomical locations are known: the superior and the inferior lumbar triangle. The aim of this systematic review is to provide a clear overview of the existing literature and make practical clinical recommendations for proper diagnosis and treatment of the primary lumbar hernia.

Methods

The systematic review was conducted according to the PRISMA guidelines. A systematic search in PubMed, MEDLINE, and EMBASE was performed, and all studies reporting on primary lumbar hernias were included. No exclusion based on study design was performed. Data regarding incarceration, recurrence, complications, and surgical management were extracted.

Results

Out of 670 eligible articles, 14 were included and additional single case reports were analysed separately. The average quality of the included articles was 4.7 on the MINORS index (0–16). Risk factors are related to increased intra-abdominal pressure. CT scanning should be performed during pre-operative workup. Available evidence favours laparoscopic mesh reinforcement, saving open repair for larger defects. Incarceration was observed in 30.8% of the cases and 2.0% had a recurrence after surgical repair. Hematomas and seromas are common complications, but surgical site infections are relatively rare.

Conclusion

The high risks of incarceration in lumbar hernias demand a relatively fast elective repair. The use of a mesh is recommended, but the surgical approach should be tailored to individual patient characteristics and risk factors.
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Metadata
Title
Pitfalls and clinical recommendations for the primary lumbar hernia based on a systematic review of the literature
Authors
S. van Steensel
A. Bloemen
L. C. L. van den Hil
J. van den Bos
G. J. Kleinrensink
N. D. Bouvy
Publication date
01-02-2019
Publisher
Springer Paris
Published in
Hernia / Issue 1/2019
Print ISSN: 1265-4906
Electronic ISSN: 1248-9204
DOI
https://doi.org/10.1007/s10029-018-1834-9

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