From the Guidelines
Grynfeltt hernias should be managed surgically as soon as possible, especially when intestinal strangulation is suspected, to prevent complications and improve outcomes. The primary treatment is surgical repair, which typically involves reducing the hernia contents back into the abdominal cavity and closing the defect in the posterior abdominal wall. This can be performed using either an open or laparoscopic approach, with the latter offering advantages of smaller incisions, less postoperative pain, and faster recovery.
Key Considerations
- Emergency hernia repair is recommended immediately when intestinal strangulation is suspected 1, as delays can lead to increased morbidity and mortality.
- Systemic inflammatory response syndrome (SIRS), contrast-enhanced CT findings, as well as lactate, CPK, and D-dimer levels are predictive of bowel strangulation 1, and should be considered in the diagnosis.
- The use of mesh in clean surgical fields (CDC wound class I) is associated with a lower recurrence rate 1, and is recommended for patients with intestinal incarceration and no signs of intestinal strangulation or concurrent bowel resection.
- For patients having complicated hernia with intestinal strangulation and/or concomitant need of bowel resection without gross enteric spillage (clean-contaminated surgical field, CDC wound class II), emergent prosthetic repair with a synthetic mesh can be performed 1, without an increase in 30-day wound-related morbidity, and is associated with a significant lower risk of recurrence.
Postoperative Care
- Postoperative pain management includes acetaminophen 1000mg every 6 hours and ibuprofen 400-600mg every 6-8 hours for mild to moderate pain, with opioids like oxycodone 5-10mg every 4-6 hours reserved for severe pain.
- Activity restrictions typically include avoiding heavy lifting (>10 pounds) for 4-6 weeks.
Conclusion Not Applicable
Surgical intervention is necessary because Grynfeltt hernias occur in the superior lumbar triangle, a naturally weak area of the posterior abdominal wall, making them prone to enlargement and potential incarceration or strangulation of abdominal contents. Conservative management with abdominal binders may be considered only for patients who are poor surgical candidates, but this approach does not address the underlying anatomical defect and carries ongoing risk of complications.
From the Research
Grynfeltt Hernia Management
- The management of Grynfeltt hernia typically involves surgical repair, with the goal of preventing complications and recurrence 2, 3, 4, 5.
- The choice of surgical approach depends on various factors, including the size and location of the hernia, as well as the patient's overall health and medical history.
- Open surgery and laparoscopic approaches are both described in the literature, with each having its own advantages and disadvantages 2, 3, 4, 5.
- The use of prosthetic materials, such as mesh, is commonly employed in the repair of Grynfeltt hernias to provide additional support and prevent recurrence 3, 4, 5, 6.
Surgical Approaches
- Open surgery is a widely used approach for the repair of Grynfeltt hernias, and can be performed under general or local anesthesia 2, 3, 4, 5.
- Laparoscopic approaches, including endoscopic retroperitoneal repair, are also being used with increasing frequency, and offer the potential benefits of reduced recovery time and less postoperative pain 6.
- The choice of surgical approach should be individualized based on the specific needs and circumstances of each patient.
Use of Prosthetic Materials
- The use of prosthetic materials, such as mesh, is an important aspect of Grynfeltt hernia repair, as it can help to provide additional support and prevent recurrence 3, 4, 5, 6.
- Self-fixating mesh is a type of mesh that does not require traumatic fixation, and may be advantageous for nerve preservation 6.
- The choice of prosthetic material should be based on the specific needs and circumstances of each patient, as well as the surgeon's preference and experience.