Spigelian Hernia: A Complication of Laparoscopic Cholecystectomy

Abstract

Spigelian hernia is a rare abdominal wall hernia. It constitutes about 0.12% of all abdominal wall herniae; the peak occurrence being between the ages of 40-70 years with a male to female ratio of 1:1.18. Owing to the rarity of the disease, lack of physician experience and absence of typical hernia-like symptoms, it is a fairly difficult condition to diagnose. There is a 20% incidence of strangulation reported in the literature. The elective treatment of a Spigelian hernia is surgical: open or laparoscopic. The latter is preferred due to reduced mortality, shorter hospital stay, better cosmetic result and perhaps a lower recurrence rate. Reported here is a case of Spigelian hernia that presented to our institution, a level 1 trauma centre, as a complication of laparoscopic abdominal surgery.

Spigelian Port-site Hernia, a Complication after Laparoscopic Cholecystectomy - a Clinical Case Report

“…Trocar-site hernias are rare complications following laparoscopic cholecystectomy with an incidence of 1.7%, most often being caused by 10 mm trocars [7]. Potential Spigelian hernias caused by trocar ports are rare [6] and in our observation the parietal defect occurred at the trocar site in the right abdominal fl ank used for a laparoscopic cholecystectomy.…”

“…Spiegelian hernia is a rare entity (1-2% of all abdominal wall hernias) [3,6], about 1000 cases being quoted in literature [6]. In the casuistry of the past 10 years of the Surgery Clinic 1 of the County Emergency Hospital Tîrgu Mureş, Fig.…”

“…• Special type: dehiscence of the whole abdominal wall with the protrusion of the intestines and other tissues. If the trocars are placed between the crescent line laterally and the rectus abdominis muscle medially, at the level of the semilunar line or close to it, Spigelian port-site hernias may result as the literature shows [6]. Th is paper wishes to warn as to the risk of port-site hernia after inadvertent placement of small laparoscopic trocars through a herniar region (Spangen's hernia belt).…”

“…Our observation describes a 60 year-old normostenic patient, with a history of laparoscopic cholecystectomy, where a late-onset type Spigelian trocar-site hernia was a result of wrong laparoscopic port placement in the right abdominal fl ank. Only one case of similar hernia has been recorded in the literature [6], the etiology and evolution of this particular condition being a diagnostic challenge.…”

“…Out of all abdominal wall defects, Spigelian hernias account for 1-2% [3], incarceration occurring only in 20% of all cases [4] .Th e factors responsible for the development of this type of hernia are: obesity, chronic constipation, ascites, poor tissue quality, multiple pregnancies and peritoneal dialysis [5]. Th e condition is more common in females (male/female ratio 1:1.18), with a peak incidence in the fi fth decade of life [2], and mainly occurs to the right of the umbilicus [6]. Th e clinical diagnosis is diffi cult due to uncharacteristic symptoms and signs, often confusing the physician.…”