Emergent Laparoscopic Repair of a Spigelian Hernia: Case Report and Review of the Literature

Barker, Reid S.; Gill, Richdeep S.; Brar, Avneet S.; Birch, Daniel W.; Karmali, Shahzeer

doi:10.1155/2013/197561

Cited by 9 publications

(7 citation statements)

References 17 publications

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“…The violation of peritoneal layer seems to be the main advantage of TEP approach, but intraabdominal SH repair was recommended as a gold standart technique due to its technical and economic advantages in a recent study (9). Independent of laparoscopic operation type, less postoperative infectious complications, less recurrence rate, less postoperative pain, less hospital stay, and early resumption of daily activities are the main advantages of laparoscopic techniques (10). However, the laparoscopic approach requires a longer learning curve as a disadvantage.…”

Section: Discussionmentioning

confidence: 99%

A rare case of Spigelian hernia combined with direct and indirect inguinal hernias

2017

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Spigelian hernia is a rare type of ventral hernias with nonspecific symptoms and signs. Therefore, its diagnosis is often difficult and requires more clinical attention. Although intermittent abdominal swelling and pain are the main symptoms, Spigelian hernias can be sometimes asymptomatic and are discovered incidentally at the operation. In some cases, these hernias can be associated with other abdominal wall hernias, therefore a detailed physical examination of the patients is necessary to avoid mistakes in diagnosis. Herein, we report an interesting and educational case of Spigelian hernia with accompanying ipsilateral both direct and indirect inguinal hernias in a male patient treated by open surgical repair with use of polypropylene mesh. Keywords:Abdominal wall hernia, inguinal hernia, Spigelian hernia, ventral hernia INTRODUCTIONInguinal hernia is one of the most common surgical disorders in general surgery practice. Indirect form of inguinal hernia is characterized by the presence of a protruding peritoneal sac through the deep inguinal ring. However, Spigelian hernia (SH) is an uncommon type of hernia with an incidence of 0.1-2% of all abdominal wall hernias (1). SH, also known as hernia of semilunar line, is the protrusion of preperitoneal fat, peritoneal sac or intraabdominal organs through a congenital or acquired defect in the Spigelian zone. This zone is formed by the fusion of transverse abdominis and internal oblique aponeurosis, and is bounded medially by the lateral margin of the rectus muscle and laterally by the linea semilunaris. Although the Spigelian aponeurosis extends from the pubic tubercle to the costal cartilage of the eighth rib, most of SHs are located in a 6 cm wide region inferior to the umbilicus and superior to the interspinous line, which is called as the Spigelian hernia belt (Figure 1). However, low SH is rare and may mimic inguinal hernias. Additionally, coexistence of Spigelian and inguinal hernia is an extremely rare clinical entity. To our knowledge, there is a small number of cases of SH combined with inguinal hernia in the literature. Herein, we report a case of low SH with incidentally found coexisting ipsilateral inguinal hernia in a 62 years-old male patient. CASE PRESENTATIONA 62-years-old-man presented with a painful abdominal swelling at the right lower quadrant of abdomen for approximately 3 years. He was retired with a medical past of umbilical hernia repair and laparoscopic cholecystectomy before 10 and 6 years, respectively, and diabetes mellitus under treatment. Abdominal examination revealed the presence of a painful, reducible bulge located between the umbilicus and right anterior superior iliac spine (Figure 2). The mass was more prominent while the patient was standing and coughing. Ultrasound (US) revealed a fascial defect, 18 mm in diameter, at the lateral border of the rectus muscle in the right lower quadrant with herniation of bowel loops. The hernia sac was revealed by transverse skin incision, and it was seen that there was not any sign of incarcer...

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Section: Discussionmentioning

confidence: 99%

A rare case of Spigelian hernia combined with direct and indirect inguinal hernias

2017

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“…6 Moreover, some reports suggest that rates of incidence are higher in patients who have had prior abdominal surgery (including both open and laparoscopic). 14 This is reflected in our series, where 18 patients had prior abdominal surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Only a third of patients present with a swelling lateral to the rectus sheath that may become prominent on sitting forward. 3,6 Although a spigelian hernia protrudes through the transverses abdominis, it remains covered by the external oblique aponeurosis making it more difficult to palpate. 4 Furthermore, because of increasing levels of abdominal obesity in recent times, clinical detection rates are considerably reduced.…”

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confidence: 99%

Laparoscopic Spigelian Hernia Repair

Kelly

Courtney

McDermott

et al. 2015

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Spigelian hernias are a rare abdominal wall hernia. The aim of this study was to assess the efficacy and outcomes of patients who underwent a laparoscopic spigelian hernia repair. A retrospective study was performed reviewing all patients who had a laparoscopic spigelian hernia repair. We assessed the success of the procedure including conversion rates, postoperative morbidities, and recurrence rates. Forty patents had a laparoscopic repair. Two thirds (n=25) had an intraperitoneal repair. There was no conversion to open repair. Four patients had postoperative morbidities. At 6-month follow-up all patients were pain free, with 1 recurrence. There is considerable evidence supporting the opinion that laparoscopic repair offers excellent outcomes. This report is the largest series to date, and we advocate that this approach should become the standard of care.

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“…Didelė pacientų dalis skundžiasi vien tik skausmu Špigelio fascijos vietoje, be palpuojamos išvaržos. Tokiais atvejais rekomenduojama instrumentinė diagnostika [8][9][10].…”

Section: Klinikinis Pasireiškimasunclassified

Špigelio Išvarža: Literatūros Apžvalga Ir Vilniaus Miesto Klinikinės Ligoninės Patirtis

Dailidėnas¹,

Trusov²,

Činčikas³

et al. 2017

Medicinos Teorija Ir Praktika

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Reikšminiai žodžiai: Špigelio išvarža, hernioplastika, pusmėnulinė linija. Špigelio išvarža – reta chirurginė patologija, sudaranti apie 1–2 proc. visų pilvo sienos išvaržų. Tikslai ir metodai. Straipsnyje siekta įvertinti Vilniaus miesto klinikinės ligoninės patirtį diagnozuojant ir gydant Špigelio išvaržas. Pateikta retrospektyvinė ligonių analizė su nustatyta Špigelio išvaržos diagnoze nuo 2012 iki 2016 m., demografiniai rodikliai, diagnostikos ir gydymo ypatumai. Pooperacinis periodas buvo įvertintas susisiekus su pacientais nurodytais kontaktiniais telefonais. Atlikta literatūros apžvalga naudojant „Pubmed“ duomenų bazę. Atrinkti, autorių duomenimis, aktualiausi straipsniai nuo 2000 iki 2016 m. Rezultatai. Per tyrimo laikotarpį nuo 2012 m. skyriuje gydyti 6 pacientai su nustatyta Špigelio išvaržos diagnoze. Vidutinis sirgusiųjų amžius – 51,16 m. Pasiskirstymas tarp lyčių: 1 (16,7 proc.) vyras ir 5 (83,3 proc.) moterys. 5 (83,3 proc.) pacientams diagnozė nustatyta kliniškai, 1 (16,7 proc.) diagnozė patvirtinta atlikus pilvo sienos echoskopiją. 66,7 proc. (n = 4) pacientų išvarža buvo kairėje, o 33,3 proc. (n = 2) atvejų – dešinėje. Vidutinis išvaržos vartų plotis 2,35 cm. 66,7 proc. (n = 4) pacientų atlikta atvira operacija, iš jų 75 proc. (n = 3) atlikta plastika savais audiniais, o 25 proc. (n = 1) – preperitoniškai tinkleliu. 33,3 proc. (n = 2) atlikta laparoskopinė hernioplastika tinkleliu. Vidutinė hospitalizacijos trukmė – 1,83 dienos. Vertinant pooperacinį laikotarpį, su 1 (16,7 proc.) pacientu susisiekti nepavyko, 5 (83,3 proc.) pacientai buvo apklausti telefonu, iš jų 4 (80 proc.) nustatytos nekomplikuotos pooperacinės eigos, 1 (20 proc.) pacientui dėl lėtinio skausmo pjūvio srityje pooperaciniu laikotarpiu atliktos injekcijos vietiniu anestetiku (markainu). Recidyvo nepastebėta nė vienam pacientui. Išvados. Špigelio išvarža – reta chirurginė patologija, todėl tyrimo galimybės ribotos dėl mažos pacientų imties. Dėl didelio įstrigimo dažnio šios išvaržos visada turėtų būti gydomos chirurgiškai. Pilvo sienos echoskopija – vertinga diagnostinė priemonė dėl mažų finansinių sąnaudų, didelio jautrumo ir teigiamos prognostinės vertės. Dėl mažo epidemiologinio dažnio, chirurgų patirties, ilgos mokymosi kreivės, specialių tinklelių ir instrumentų poreikio didelė dalis šių išvaržų operuojama atviru būdu. Tačiau minimaliai invazyvios Špigelio išvaržų operacijos pranašesnės dėl trumpesnio pooperacinio laikotarpio stacionare, kosmetinio efekto ir, manoma, mažesnio recidyvų skaičiaus.

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Emergent Laparoscopic Repair of a Spigelian Hernia: Case Report and Review of the Literature

Cited by 9 publications

References 17 publications

A rare case of Spigelian hernia combined with direct and indirect inguinal hernias

A rare case of Spigelian hernia combined with direct and indirect inguinal hernias

Laparoscopic Spigelian Hernia Repair

Špigelio Išvarža: Literatūros Apžvalga Ir Vilniaus Miesto Klinikinės Ligoninės Patirtis

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