Grynfeltt–Lesshaft hernia. Personal experience of nine cases and a review of the literature

Abstract

Grynfeltt’s lumbar hernia, from the author who first described it in 1866, is the rarest among all hernias of the abdominal wall and it represents, according to the most recent literature, only 2% of all hernias. Of these, about 20% are congenital, secondary mainly to defects of embryonic development, while 80% are acquired defects. Surgeries, penetrating wounds, and infections are risk factors for the development of secondary and therefore iatrogenic lumbar hernias. In the literature, there is a predominance of the left Grynfeltt hernia while a bilateral presentation is exceptional. Our recent observation of a massive Grynfeltt hernia brought us to perform a revision of the literature and of our case studies. Based on our personal experience, with the most recent literature, we believe that in the case of Grynfeltt’s lumbar hernias, the laparotomy approach with the use of prosthetic materials is the most appropriate, thus making the procedure fast, easy, and safe, compared to the treatment of all other wall defects that often require a laparoscopic approach. To confirm this, it is perceived that the open technique is currently more widespread; in fact, a small lumbotomy is easy to perform, fast, and can also be performed under loco-regional or epidural anaesthesia.