Original article Minilaparoscopic treatment of a Grynfeltt lumbar hernia Gustavo L. Carvalho a,b, *, Diego Laurentino Lima c , Raimundo Hugo Matias Furtado d , Gustavo Henrique Belarmino de Góes e , Prashant Rao f a University of Pernambuco (UPE), Faculty of Medical Sciences, Recife, Brazil b Clinica Cirurgica Videolaparoscopica Gustavo Carvalho, Recife, (Clinical Research Group from University of Pernambuco), Brazil c General surgery resident, State Servers Hospital, Brazil d General Surgery resident, University of Pernambuco (UPE), Brazil e Medical Student at University of Pernambuco (UPE), Faculty of Medical Sciences, Recife, Brazil f Director of Gastrointestinal and Minimal Access Surgery, Global Hospitals, Mumbai, India A R T I C L E I N F O Article history: Received 2 February 2018 Accepted 26 February 2018 Available online 27 February 2018 Keywords: Micro-laparoscopy Needlescopic Surgery Hernia Pre-peritoneal Mini-laparoscopy Microlaparoscopy Minimally invasive TEP A B S T R A C T Aim: This study reports a successful minilaparoscopic treatment of a 62 years old male patient with a Grynfeltt hernia, and outlines a new minimally invasive way to do the procedure. A patient presented with a left lumbar herniation of two years duration with no other symptoms. Physical examination showed a 5 cm soft mass on the left lumbar region, which was confirmed as a hernia by an ultrasound. Method: A minilaparoscopic approach to surgery was chosen, using a 10 mm trocar inserted in the umbilical region for pneumoperitoneum and the optics, a 3 mm minilaparoscopy trocar inserted in the preperitoneal region in the left iliac region and another 3 mm trocar inserted more dorsally in the lumbar region. Results: The polypropylene mesh was placed in the preperitoneal space without need for any mesh fixation. The total time of surgery was 41 min and the patient was discharged on the next day. Conclusion: The proposed novel approach is not only feasible, but offers advantages as it appears to be safer, less invasive, cost-effective and above all eminently reproducible. © 2018 Published by Elsevier, a division of RELX India, Pvt. Ltd on behalf of Sir Ganga Ram Hospital. 1. Introduction Lumbar hernia is the protrusion of intraperitoneal or extraperi- toneal contents through a defect of the posterolateral abdominal wall. Barbette was the first to suggest the existence of lumber hernias in 1672 but the first case was reported by Garangeot in 1731. Petit and Grynfeltt delineated the boundaries of the inferior and superior lumbar triangles in 1783 and 1866, respectively. 1,2 Lumbar hernias can be congenital (20%) or acquired. Acquired hernias are divided into primary and secondary. 3,4 Primary lumbar hernias are classified according to the anatomical location: lower hernia (Petit), and upper hernia (Grynfeltt-Lesshaft). 4 Grynfeltt- Lesshaft hernia are herniation of the abdominal contents through the back, specifically through the superior lumbar triangle, which is defined by the quadratus lumborum muscle, twelfth rib, and internal oblique muscle. Secondarily acquired lumbar hernias are associated with prior surgical incisions, trauma, or abscess formation. Traditionally, the repair would involve an incision from the 12th rib to the iliac crest. Recently, however, laparoscopic procedures have been reported with success. We describe the treatment of a Grynfeltt hernia by a minilaparoscopic TEP (Totally Extraperitoneal) technique. There are no reports in the literature regarding the use of minilaparoscopy for the treatment of a Grynfeltt hernia. 2. Material and methods 2.1. Clinical case A 62 years old, male patient presented with no previous history of abdominal surgery and a left lumbar swelling of two years duration without any other symptoms. Patient denied any trauma that could be associated with the appearance of the hernia. Physical examination showed a 5 cm soft mass on the left lumbar region (Fig. 1A), which was confirmed by an ultrasound as a lumbar hernia with a 2 cm defect. A combined TAPP-TEP minilaparoscopic approach to surgery was chosen. * Corresponding author at: Avenida Boa Viagem, 5526B Apt., 1902, Recife, PE, CEP, 51030-000, Brazil. E-mail addresses: glcmd1@gmail.com (G.L. Carvalho), dilaurentino@gmail.com (D.L. Lima), hugomatiasfurtado@gmail.com (R.H.M. Furtado), pprao2@icloud.com (P. Rao). https://doi.org/10.1016/j.cmrp.2018.02.005 2352-0817/© 2018 Published by Elsevier, a division of RELX India, Pvt. Ltd on behalf of Sir Ganga Ram Hospital. Current Medicine Research and Practice 8 (2018) 52–58 Contents lists available at ScienceDirect Current Medicine Research and Practice journa l homepage: www.e lsevier.com/locate/cmrp