No mesh, no problem: an innovative surgical approach to a primary superior lumbar hernia repair.

Superior lumbar hernias are rare abdominal wall defects that protrude through the superior lumbar triangle and are often misdiagnosed due to their infrequency. This case highlights the successful mesh-free repair of a superior lumbar hernia in a 64-year-old patient, who initially presented with a growing lump and intermittent pain. Though initially suspected to be a sub-fascial lipoma, magnetic resonance imaging was crucial in revealing the true diagnosis. The patient underwent a primary Mayo repair without mesh due to favorable surrounding tissue quality. This report emphasizes the importance of considering lumbar hernias as a differential diagnosis despite their rarity, the potential role of magnetic resonance imaging as an effective imaging modality for diagnosis and surgical planning, and provides strong evidence to support the viability of mesh-free repair techniques in specific cases with good muscle quality.