There hernias occur as lumps in the flank or the lower back. A majority of these hernias are secondary to surgery (see incisional hernia) and trauma following major road traffic accidents. There are also the rare ones which occur in potential areas of weakness between the muscles in the back. There are called superior (Grynfellt-Lesshaft) and inferior (Petit) lumbar hernias.
Repair or wait and see.
The more common incisional and traumatic hernias are best repaired early when they are small as there a high likelihood that they would enlarge, and some do so quite rapidly. Larger ones are more challenging to repair. The challenge in repairing lumbar hernias, especially the large ones, is that the muscles become considerably weakened and the edges of these hernias may not have much muscle overlying the surrounding bones in this area to suture and for the mesh to integrate with. Special techniques are then needed to successfully operate these, so these hernias are best performed by specialist surgeons.
Open or laparoscopic (key-hole)
Both can be effective but laparoscopic repairs are associated with shorter hospital stays and quicker recovery. Special key-hole techniques and instruments are required to close the muscle defect and we believe that a mesh is required to reinforce the whole area, well beyond the hernia defect, as described with stoma hernias. Without a mesh, there is a high risk of recurrence.
