Spigelian hernia: Personal experience and review of the literature

Abstract

Objective: Spigelian hernia is an uncommon abdominal wall defect. We present our series of patients with Spigelian hernia and a literature review.Patients: We carried out a retrospective review of patients operated on from 2001 to 2008. Epidemiological aspects, diagnostic methods, surgical technique characteristics, morbidity, hospital stay, recurrences and follow up are analyzed.Results: We have treated 39 patients, 25 female and 14 male, with a mean age of 70 years. Left side was the most frequent location. Risk factors were present in 74% of patients. Diagnosis was made clinically in 72% of cases. Open hernioplasty followed by laparoscopic hernioplasty are the most frequent techniques performed. Emergency operation was needed in 20% of patients. Postoperative morbidity is very low.Conclusions: Diagnosis of Spigelian hernia is basically clinic. The gold standard is TC in doubtful cases. An important percentage of patients will present with an acute complication of the Spigelian hernia as their first symptom. Surgical technique depends on patient characteristics, type of hernia and surgeon experience.Key words: Spigelian hernia. Ventral hernia. Laparoscopy. Mesh. RESUMENObjetivo: la hernia de Spiegel es una variedad poco frecuente de defecto de la pared abdominal. Presentamos nuestra serie de pacientes intervenidos con éste diagnóstico, así como una revisión de la literatura.Pacientes: se realiza un estudio retrospectivo de los pacientes intervenidos por hernia de Spiegel en nuestro centro entre los años 2001 y 2008. Se analizan factores epidemiológicos, forma de diagnóstico, características de la técnica quirúrgica, morbilidad, estancia hospitalaria, recidivas y seguimiento.Resultados: han sido intervenidos 39 pacientes, 25 mujeres y 14 hombres, con una edad media de 70 años. La localización más frecuente es la izquierda. El 74% de los pacientes presenta 1 o más factores de riesgo. El diagnóstico fue clínico en el 72% de los casos. La técnica más empleada es la hernioplastia seguida de la hernioplastia laparoscópica y en el 20% de los casos la intervención tuvo que realizarse de forma urgente. La morbilidad postoperatoria es escasa.Conclusiones: el diagnóstico de la hernia de Spiegel es fundamentalmente clínico. En caso de duda diagnóstica el TAC es la prueba de elección. En un porcentaje importante de pacientes la primera manifestación es la incarceración. La técnica quirúrgica dependerá de las características del paciente, la hernia y la experiencia del cirujano Palabras clave: Hernia de Spiegel. Hernia ventral lateral. Laparoscopia. Malla.

Laparoscopic Transabdominal Preperitoneal Repair of Spigelian Hernia—Closure of the Fascial Defect Is Not Necessary

“…49,50 The most commonly reported (39%) laparoscopic method of SH repair is the intraperitoneal onlay mesh technique. 12,13,[16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] This procedure involves reduction of the hernial contents and placement of a composite mesh directly on the abdominal wall. Although the technique is relatively simple, its major drawbacks are the possibility of interactions between peritoneal contents and the mesh potentially causing significant complications.…”

“…Of the laparoscopic SH repairs reported in the literature, the most popular repair is the intraperitoneal onlay mesh method, followed by transabdominal preperitoneal (TAPP) repair. 12,13,[16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] The majority of surgeons reporting use of the TAPP repair close the defect despite there being no evidence in the literature supporting this. 16,19,31,[34][35][36] Here we report the outcome of the largest series of patients undergoing laparoscopic TAPP repair of SH that deliberately omits approximation of the fascial defect.…”

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

“…Symptoms are often nonspecific and are likely to be pain and nausea. Vomiting and altered bowel habits may also be of the presenting complaints [11]. Physical exam is most helpful when a palpable lump is present, although the swelling caused by the underlying hernia is often masked by the overlaying external oblique aponeurosis [1].…”

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

“…In a retrospective study of 76 cases at the Mayo Clinic, only 64% of all SH patients could be diagnosed by physical examination (4). In another study, preoperative diagnosis was made clinically in 72% of cases (5). Therefore, a high index of suspicion and additional radiological investigations are generally required for the diagnosis of SH.…”

“…However, these hernias may be occasionally associated with other abdominal wall hernias (5). In a case series, 4 of 6 patients with SH had concomitant hernias including groin, umbilical and incisional hernias (11).…”