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Lumbar incisional herniae must be more common than the numbers given in literature, and although a clear definition should not be too difficult the term itself contains many different phenotypes. First and according to Korenkov’s definition a real defect in all three muscles that form the lateral abdominal wall [2]. Second the incomplete or interstitial incisional hernia in which there is no defect in the external aponeurosis but only in the internus/transversus complex which most probably was not properly closed in the original operation in the first place. Thirdly there are traumatic lumbar abdominal defects, often caused by seatbelts or in former times by cancellous bone-harvesting procedures out of the iliac crest by orthopedic surgeons, where the latter forms a real incisional hernia, while in case of a traumatic abdominal wall rupture, mostly due to a blunt trauma, there will be no scar. These conditions are different to defects because of tissue-loss of the abdominal wall, caused by deliberate removal of muscle-tissue for oncologic reasons.One should realize that contrary to the midline laparotomy via the linea alba a “lumbotomy” might refer to a “classic” one, a vertical pararectal incision, a dorsal lumbotomy variant or variations on these [3], indicating that, as there does not exist a so-called standard lumbotomy, there will be no standard incisional lumbar herniae and subsequently no real standard technique to repair such a hernia. However, Renard presents a standard principle how to deal with this condition.

hernia

Invited comment to: Open retromuscular large mesh reconstruction of lumbar incisional hernias including the atrophic muscular area. Y. Renard, L. de Mestier, A. Cagniet et al.