# No mesh, no problem: an innovative surgical approach to a primary superior lumbar hernia repair

## TL;DR

A rare case of a superior lumbar hernia was successfully repaired without mesh in a 64-year-old patient.

## Contribution

This case report demonstrates the viability of mesh-free repair for superior lumbar hernias when muscle quality is sufficient.

## Key findings

- A mesh-free Mayo repair was successfully used for a superior lumbar hernia with good tissue quality.
- MRI was critical for accurate diagnosis and surgical planning.
- The case supports considering lumbar hernias in differential diagnoses despite their rarity.

## Abstract

Superior lumbar hernias are rare abdominal wall defects that protrude through the superior lumbar triangle and are often misdiagnosed due to their infrequency. This case highlights the successful mesh-free repair of a superior lumbar hernia in a 64-year-old patient, who initially presented with a growing lump and intermittent pain. Though initially suspected to be a sub-fascial lipoma, magnetic resonance imaging was crucial in revealing the true diagnosis. The patient underwent a primary Mayo repair without mesh due to favorable surrounding tissue quality. This report emphasizes the importance of considering lumbar hernias as a differential diagnosis despite their rarity, the potential role of magnetic resonance imaging as an effective imaging modality for diagnosis and surgical planning, and provides strong evidence to support the viability of mesh-free repair techniques in specific cases with good muscle quality.