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Background: Traumatic lumbar hernias (TLH) are a rare clinical entity with fewer than 100 cases reported in the English literature worldwide. Due to the surrounding anatomy, surgical repair is often difficult. There is currently no consensus on the timing of operative repair of TLH. The aim of this study is to present a case series on the management of TLH performed at the Royal Brisbane and Women's Hospital (RBWH) utilizing both open and laparoscopic techniques with both early and delayed repairs being undertaken.Methods: Cases were identified retrospectively from the Trauma Database at the RBWH, a tertiary-level hospital in Brisbane, Australia.Results: Four cases of TLH were identified from 2009 to 2014. The diagnosis was confirmed pre-operatively on CT imaging. Early repair was undertaken when the patient was stable from other associated injuries. Herniation was managed in three cases by open repair (2x open lumbar approaches, 1 via midline laparotomy) with sublay extraperitoneal mesh placement. The remaining case was managed by laparoscopic extra-peritoneal mesh repair. At a minimal 4 months follow-up, no evidence of recurrence or complications was detected in three cases. One patient was lost to follow-up.Conclusions: TLH are a rare clinical entity. Operative management can be achieved via open or laparoscopic techniques, with placement of mesh in the extraperitoneal plane. Both early, when the patients clinical status allows, and delayed repair appear to have good short-term results. Long-term data are not available at this stage. [ABSTRACT FROM AUTHOR]

Background: Increased esophagogastric junction distensibility occurs with esophageal reflux. The EndoFLIP(®) is now available as a clinical tool to measure this. Control data for patients without reflux has to date only been available for a handful of patients evaluated under sedation during endoscopy. This study explores the baseline data for patients who undergo laparoscopy using general anesthesia with pneumoperitoneum.Methods: Patients who require surgery in the absence of a history of esophageal reflux underwent EndoFLIP(®) evaluation of pressure, cross-sectional area, and distensibility with bag fills of 30 and 40 ml. This was performed after induction of anesthesia, during pneumoperitoneum, and just before extubation.Results: Baseline levels were established and were noted to be significantly affected by the impact of pneumoperitoneum, with negligible effects from general anesthesia, patient gender, age, body mass index, or muscle relaxation.Conclusions: These data provide a guide for more accurate intraoperative EndoFLIP(®) calibration of crural hiatal repair during surgery. [ABSTRACT FROM AUTHOR]