Laparoscopic Transabdominal Preperitoneal Repair of a Primary Upper Lumbar Hernia: A Case Report

TL;DR

A 56-year-old woman with a rare upper lumbar hernia was successfully treated with a laparoscopic repair, highlighting the importance of early imaging for diagnosis.

Contribution

This case report presents a successful laparoscopic TAPP repair for a primary upper lumbar hernia with atypical presentation.

Findings

Lumbar hernias can present with vague symptoms and no visible mass, requiring high clinical suspicion for diagnosis.

Laparoscopic TAPP repair is a viable and effective treatment option for primary upper lumbar hernias.

Early imaging is crucial to confirm diagnosis and prevent complications.

Abstract

Lumbar hernias are a rare type of hernia, arising through posterolateral abdominal wall defects containing either intraperitoneal or extraperitoneal contents. Most lumbar hernias are primary, incisional, or trauma-related, while congenital lumbar hernias are uncommon. Surgical management comes down to two approaches: the classic repair technique with an open approach utilizing a lumbar incision and the laparoscopic approach, either transabdominal preperitoneal (TAPP) or totally extraperitoneal (TEP). We present the case of a 56-year-old female patient who was evaluated in the outpatient surgical clinic, complaining of pain located between the left midaxillary line and the left lumbar region. The patient underwent a CT scan, and a diagnosis of a left upper lumbar hernia was made. The patient underwent a laparoscopic TAPP repair and was discharged on postoperative day one. Our case highlights that lumbar hernias can present with vague symptoms and without an obvious lump/mass, a diagnosis of which could require a great degree of clinical suspicion especially when there is no history of trauma or surgery in the area. Early imaging can confirm the diagnosis, and surgical repair should be conducted to prevent possible complications.

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