Contemporary thoughts on the management of Spigelian hernia

Webber, Victoria; Low, Chen Sheng; Skipworth, Richard J.E.; Kumar, Sunil; Beaux, A. C. de; Tulloh, Bruce

doi:10.1007/s10029-017-1579-x

Cited by 58 publications

(91 citation statements)

References 15 publications

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“…In younger patients, however, a hernia may only contain extraperitoneal fat with no defect visible from within the peritoneum [12]. In the case series by Webber et al [3], one third of patients had a SH comprised of extraperitoneal fat only with no peritoneal component; 3 laparoscopic repairs were converted to open because no defect was visible at laparoscopy. The first extraperitoneal approach was published by Moreno-Egea et al [13] in 1999.…”

Section: Discussionmentioning

confidence: 99%

“…The largest case series from Webber et al [3] describes laparoscopic Spigelian repair in 42 patients. Four different laparoscopic techniques were used, e.g.…”

Section: Discussionmentioning

confidence: 99%

“…It has variable incidence quoted in the literature ranging from 0.1 to 2% [1,2,3]. Named after Adrian van der Spieghel, the 17th century Belgian anatomist who first described the semilunar line, it was not until 1764 that it was first reported as a clinical entity by the Flemish anatomist Josef Klinkosh.…”

Section: Introductionmentioning

confidence: 99%

“…SH can be congenital or acquired, appear to peak around the fifth decade, and are slightly more common in women [1,4]. Diagnosis of SH can be difficult as they tend to be masked by abdominal fat and the aponeurosis of the external oblique [3]. Surgery is advisable as there is a higher risk of strangulation and incarceration in up to 24% due to the sharp fascial margin around the defect [5].…”

Section: Introductionmentioning

confidence: 99%

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Spigelian Hernia: Case Series and Review of the Literature

Rankin

Kostusiak

Sokker³

2018

Visc Med

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Background: Spigelian hernia (SH) is an uncommon ventral abdominal hernia. Traditionally repaired with an open technique, the laparoscopic approach is becoming more common and widely described in the literature. We hold that the transabdominal preperitoneal (TAPP) approach restores the anatomy and prevents complications such as seroma. We present a series of SH repair carried out at a single district general hospital over the past 13 years and a review of the literature. Methods: A retrospective case note review identified SH repaired between January 2005 and March 2018 at The Queen Elizabeth Hospital, King's Lynn, Norfolk, UK. A Medline search for ‘Spigelian hernia' and ‘laparoscopic' revealed 41 papers for review. Results: 33 patients underwent repair of SH. We found that the TAPP repair with a mesh is anatomically the most sound repair, with all the added benefits of keyhole surgery, i.e. reduced hospital stay, quicker recovery, and fewer infections. Our complication rates matched those described in the literature. Conclusions: Several operative techniques have been described to repair SH. We favour the laparoscopic TAPP approach which is safe, aids in confirming the correct diagnosis, and has all the benefits of keyhole surgery.

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Section: Discussionmentioning

confidence: 99%

“…The largest case series from Webber et al [3] describes laparoscopic Spigelian repair in 42 patients. Four different laparoscopic techniques were used, e.g.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Spigelian Hernia: Case Series and Review of the Literature

Rankin

Kostusiak

Sokker³

2018

Visc Med

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“…A hernia was suspected and the GP referred the patient for abdominal ultrasound performed standing and supine, with coughing and forced Valsalva. This showed a small (<1 cm) hypoechoic cyst protruding through a deficit between left external oblique and transversus abdominis, suggesting left lateral ventral (Spigelian) hernia [8]. The patient underwent laparoscopy in February 2018.…”

Section: Case Reportmentioning

confidence: 99%

Protracted diagnosis of ACNES: a costly exercise

Dancer

Macpherson²,

Beaux

2018

Journal of Surgical Case Reports

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This case report summarizes the course of events leading to diagnosis and eventual repair of anterior cutaneous nerve entrapment syndrome (ACNES) in a 58-year-old female. The time period elapsing from initial symptoms to final operative repair was 9 months. The diagnosis was missed by both medical and surgical specialists despite multiple outpatient appointments, investigative procedures and a battery of laboratory tests. The diagnosis of ACNES was first considered when reviewed by a hernia surgeon and subsequently confirmed following open exploration of the anterior abdominal wall. The nerve was released and pain symptoms resolved. Access to the NHS Scotland ISD register permitted an economic analysis of the diagnostic services utilized for this patient and these totalled nearly £11 500. At a time when the NHS is focused on cost effectiveness, this particular sequence of investigations illustrates a protracted and costly diagnostic pathway.

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EHS and AHS guidelines for treatment of primary ventral hernias in rare locations or special circumstances

et al. 2020

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Background Rare locations of hernias, as well as primary ventral hernias under certain circumstances (cirrhosis, dialysis, rectus diastasis, subsequent pregnancy), might be technically challenging. The aim was to identify situations where the treatment strategy might deviate from routine management. Methods The guideline group consisted of surgeons from the European and Americas Hernia Societies. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used in formulating the recommendations. The Scottish Intercollegiate Guidelines Network (SIGN) critical appraisal checklists were used to evaluate the quality of full‐text papers. A systematic literature search was performed on 1 May 2018 and updated 1 February 2019. The Appraisal of Guidelines for Research and Evaluation (AGREE) instrument was followed. Results Literature was limited in quantity and quality. A majority of the recommendations were graded as weak, based on low quality of evidence. In patients with cirrhosis or on dialysis, a preperitoneal mesh repair is suggested. Subsequent pregnancy is a risk factor for recurrence. Repair should be postponed until after the last pregnancy. For patients with a concomitant rectus diastasis or those with a Spigelian or lumbar hernia, no recommendation could be made for treatment strategy owing to lack of evidence. Conclusion This is the first European and American guideline on the treatment of umbilical and epigastric hernias in patients with special conditions, including Spigelian and lumbar hernias. All recommendations were weak owing to a lack of evidence. Further studies are needed on patients with rectus diastasis, Spigelian and lumbar hernias.

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Contemporary thoughts on the management of Spigelian hernia

Cited by 58 publications

References 15 publications

Spigelian Hernia: Case Series and Review of the Literature

Spigelian Hernia: Case Series and Review of the Literature

Protracted diagnosis of ACNES: a costly exercise

EHS and AHS guidelines for treatment of primary ventral hernias in rare locations or special circumstances

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