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Lorenz R, Vollmer U, Conze J, Loch F, Paul-Promchan K, Mantke R, Paasch C, Wiessner R. Is there a link between Spigelian and inguinal hernias? A case series. Hernia 2024:10.1007/s10029-024-03061-5. [PMID: 38935190 DOI: 10.1007/s10029-024-03061-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 04/24/2024] [Indexed: 06/28/2024]
Abstract
INTRODUCTION Spigelian hernias are among the rare primary ventral hernias. Diagnosis is often difficult, as many cases are asymptomatic. Spigelian and inguinal hernias are usually considered separately in current scientific literature. With this case series, we want to illustrate a possible relationship between the neighboring hernia types. METHODS In this article, we report on a case series of Spigelian hernias that were operated on in five hernia centers in the period from January 1st, 2021 to October 31st, 2023. We have summarized all patient characteristics with previous operations and the result of the secondary operation. RESULTS We report a case series with 24 Spigelian hernias, 15 of which have a connection to previous inguinal hernias. In these cases, however, it is not certain whether these are primarily overlooked or occult hernias or whether these Spigelian hernias have arisen secondarily, as a result of previous hernia surgery. With this case series, we would like to point out a possible connection between Spigelian hernia and inguinal hernia. Further studies are needed to shed more light on this entity and explain its genesis.
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Affiliation(s)
- R Lorenz
- Hernia Center, 3+CHIRURGEN, Klosterstrasse 34/35, 13581, Berlin, Germany.
- Department of General and Abdominal Surgery, Clinic for General and Abdominal Surgery, Medical University Brandenburg an Der Havel, Fehrbelliner Strasse 38, 3+CHIRURGEN, Klosterstrasse 34/35, 13581, Berlin, Germany.
- Havelklinik Berlin, 3+CHIRURGEN, Klosterstrasse 34/35, 13581, Berlin, Germany.
| | - U Vollmer
- Park-Klinik Weißensee, Department of General Surgery, Schönstrasse 80, 13086, Berlin, Germany
| | - J Conze
- UM Hernienzentrum Dr. Conze, Arabellastraße 17, 81925, Munich, Germany
| | - F Loch
- Department of Surgery, Charité-Universitätsmedizin Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - K Paul-Promchan
- Department of General Surgery, Hospital Bethel Berlin, Promenadenstrasse 3-5, 12207, Berlin, Germany
| | - R Mantke
- Department of General and Abdominal Surgery, Clinic for General and Abdominal Surgery, Medical University Brandenburg an Der Havel, Fehrbelliner Strasse 38, 3+CHIRURGEN, Klosterstrasse 34/35, 13581, Berlin, Germany
- Faculty of Medicine, Brandenburg Medical School Thedor Fontane, Brandenburg, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an Der Havel, Germany
| | - C Paasch
- Department of General and Abdominal Surgery, Clinic for General and Abdominal Surgery, Medical University Brandenburg an Der Havel, Fehrbelliner Strasse 38, 3+CHIRURGEN, Klosterstrasse 34/35, 13581, Berlin, Germany
| | - R Wiessner
- Bodden-Klinik Ribnitz-Damgarten, Sandhufe 2, 18311, Ribnitz-Damgarten, Germany
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Clark CR, Kelly ML, Palamuthusingam P. Spigelian hernia: a multi-site review of operative outcomes of surgical repair in the adult population. Hernia 2024; 28:537-546. [PMID: 38261159 PMCID: PMC10997718 DOI: 10.1007/s10029-023-02946-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 12/11/2023] [Indexed: 01/24/2024]
Abstract
PURPOSE Spigelian hernias arise at the linear semilunaris and account for approximately 1-2% of abdominal hernias. The aetiology is due to a defect of the aponeurosis of the transverse abdominis and when discovered, management is surgical intervention. The aim of this study was to observe operative outcomes for open and minimally invasive repair. METHODS A retrospective chart review was conducted at two hospitals in Townsville, The Townsville University Hospital and The Mater Private Hospital over a 10-year period (2010 to 2020). A surgical database search (ORMIS & IEMR) was performed at both locations using key search terms, including "spigelian hernia", "laparoscopic", "open". Descriptive statistics were utilised to analyse patient factors and operative outcomes in the public and private setting. RESULTS 43 cases of Spigelian hernias (25 female, 18 male) were reported over the study period. The average age was 66. There were 36 elective cases and 7 emergency cases. A laparoscopic approach was the preferred method of repair, occurring in 74% of cases. Of these cases, the predominant hernial content was fat only. 65% of cases had a history of prior abdominal surgery unrelated to the "Spigelian belt" location. Complications occurred in 19% of cases. Other variables, such as ethnicity, smoking status, defect size, predisposing factors and recurrence rate, were analysed and did not yield statistical significance. CONCLUSION Although a small sample size, the data suggest there is no statistically significant difference between operative outcomes, complication rate and predisposing factors between open and minimally invasive case groups.
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Affiliation(s)
- C R Clark
- Department of General Surgery, Royal Brisbane and Women's Hospital, Brisbane, QLD, 4029, Australia.
- Department of General Surgery, Townsville University Hospital, Townsville, QLD, 4814, Australia.
- Department of General Surgery, Mater Hospital Townsville, Townsville, QLD, 4812, Australia.
- James Cook University, Townsville, QLD, Australia.
| | - M L Kelly
- Department of General Surgery, Royal Brisbane and Women's Hospital, Brisbane, QLD, 4029, Australia
| | - P Palamuthusingam
- Department of General Surgery, Royal Brisbane and Women's Hospital, Brisbane, QLD, 4029, Australia
- Department of General Surgery, Townsville University Hospital, Townsville, QLD, 4814, Australia
- Department of General Surgery, Mater Hospital Townsville, Townsville, QLD, 4812, Australia
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Lowrie NR, Richter KK, Orizu MN. Diagnosis and treatment of a rare case of an incarcerated bilateral Spigelian hernia with the vermiform appendix and caecum. BMJ Case Rep 2023; 16:e251931. [PMID: 37553169 PMCID: PMC10414057 DOI: 10.1136/bcr-2022-251931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023] Open
Abstract
Spigelian hernia is a rare form of abdominal wall defect. Bilateral Spigelian hernias are even less common. Surgical repair of Spigelian hernias is recommended due to their high risk of incarceration and strangulation of abdominal contents. A variety of surgical approaches to repair these hernias have been described in the literature including the traditional open approach, laparoscopic transabdominal preperitoneal approach, laparoscopic intraperitoneal repair and laparoscopic totally extraperitoneal repair. Here, we present the case of an elderly female patient with rare bilateral Spigelian hernias, the right side containing incarcerated appendix and caecal pole. The left hernia was unrecognised on preoperative CT imaging. To our knowledge, very few cases have been reported in the literature. The patient underwent bilateral laparoscopic intraperitoneal mesh repair. All technical aspects of the treatment are discussed here, in the context of the current literature, including the surgical technique and the limitations of the CT diagnosis. We aim to summarise the background of these uncommon hernias, the limitations of preoperative investigations and the differences between the available operative approaches.
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Affiliation(s)
- Neil Robert Lowrie
- General Surgery, University of Otago School of Medicine, Dunedin, New Zealand
- General Surgery, Southland Hospital, Invercargill, New Zealand
| | - Konrad Klaus Richter
- General Surgery, Southland Hospital, Invercargill, New Zealand
- Dean's Department, University of Otago School of Medicine, Dunedin, New Zealand
| | - Mavis N Orizu
- General Surgery, Southland Hospital, Invercargill, New Zealand
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Szasz P, Mainprize M, Spencer Netto FA. Spigelian hernias: A high volume institutional review. Surg Open Sci 2023; 13:75-81. [PMID: 37351187 PMCID: PMC10282559 DOI: 10.1016/j.sopen.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/18/2023] [Accepted: 04/24/2023] [Indexed: 06/24/2023] Open
Abstract
Purpose The objective of this study was to evaluate a high-volume hernia center's experience with primary Spigelian hernias. Introduction Spigelian hernias are rare entities presenting a diagnostic dilemma for clinicians that often lead to a delay in treatment or need for emergency surgery. Given this low incidence true patient and hernia characteristics are unknown. Methods This was a retrospective chart review evaluating patients who underwent a Spigelian hernia repair between 2005 and 2019. Descriptive statistics were utilized. Results The incidence of Spigelian hernias at our institution was 0.14 %. There were 141 patients with 143 spigelian hernias (two patients had bilateral hernias) repaired at our institution during the study period, the majority of these were in male patients, left sided and repaired under conscious sedation with or without the use of mesh. Conclusion This study adds a large dataset to the paucity of literature that exists in the context of Spigelian hernias and alerts the clinician that these hernias are not exclusive to the older female population. Furthermore, this study provides the need for a high index of suspicion in patients presenting with vague abdominal pain who may not fit the typical Spigelian hernia mold.
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Affiliation(s)
- Peter Szasz
- Department of Surgery, Queen's University, Kingston Health Sciences Center, ON, Canada
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Lode L, Jensen KK, Helgstrand F, Henriksen NA. Outcomes After Spigelian Hernia Repair: A Nationwide Database Study. World J Surg 2023; 47:1184-1189. [PMID: 36749361 DOI: 10.1007/s00268-023-06923-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2023] [Indexed: 02/08/2023]
Abstract
BACKGROUND Spigelian hernia is a rare hernia of the abdominal wall. Due to lack of evidence, there is no standard recommendation for surgical technique of Spigelian hernia repair. The aim of this study was to evaluate the outcomes after open and laparoscopic, elective and emergency repair of Spigelian hernias on a nationwide basis. METHODS Nationwide data from the Danish Ventral Hernia Database and the National Patient Registry was assessed to analyze outcomes after Spigelian hernia repair. A total of 365 patients were operated for Spigelian hernia in Denmark from 2007 to 2018. Ninety-day readmission, 90-day reoperation and long-term operation for recurrence were evaluated, as well as possible differences between open and laparoscopic, and elective and emergency repairs. RESULTS Most of the patients (80.5%, 294/365) were operated by laparoscopic approach and 19.5% (71/365) were operated by open approach. Elective surgery was performed in 83.6% (305/365) of the patients and 16.4% (60/365) underwent emergency repair. There were no significant differences in 90-day readmission or reoperation rates between open or laparoscopic Spigelian hernia repairs, P = 0.778 and P = 0.531. Ninety-day readmission and 90-day reoperation rates were also comparable for elective versus emergency repair, P = 0.399 and P = 0.766. No difference was found in operation for recurrence rates between elective and emergency, nor open and laparoscopic Spigelian hernia repairs. CONCLUSIONS This study demonstrates that 16% of Spigelian hernia repairs are done in the emergency setting. Open and laparoscopic approach are comparable in terms of early readmission, reoperation, and recurrence rates.
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Affiliation(s)
- Lise Lode
- Department of Gastrointestinal Surgery, Hvidovre Hospital, Kettegård Alle 30, 2650, Hvidovre, Denmark.
| | | | | | - Nadia A Henriksen
- Department of Gastrointestinal- and Hepatic Diseases, Surgical Section, Copenhagen University Hospital, Herlev, Denmark
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Hanzalova I, Schäfer M, Demartines N, Clerc D. Spigelian hernia: current approaches to surgical treatment-a review. Hernia 2021; 26:1427-1433. [PMID: 34665343 DOI: 10.1007/s10029-021-02511-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 09/05/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Spigelian hernias (SpH) belong to the group of eponymous abdominal wall hernias. Major reasons for diagnostic difficulties are its low incidence reaching maximum 2% of abdominal wall hernias, a specific anatomical localization with intact external oblique aponeurosis covering the hernia sac and non-constant clinical presentation. METHODS A literature review was completed to summarize current knowledge on surgical treatment options and results. RESULTS SpH presents a high incarceration risk and therefore should be operated upon even if the patient is asymptomatic. Both laparoscopic and open repair approaches are validated by current guidelines with lesser postoperative complications and shorter hospital stay in favour of minimally invasive surgery, regardless of the technique used. Overall recurrence rate is very low. CONCLUSION All diagnosed SpH should be planned for elective operation to prevent strangulated hernia and, therefore emergency surgery. Both open and laparoscopic SpH treatment can be safely performed, depending on surgeon's experience. In most cases, a mesh repair is generally advised.
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Affiliation(s)
- I Hanzalova
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Bugnon 46, 1011, Lausanne, Switzerland
| | - M Schäfer
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Bugnon 46, 1011, Lausanne, Switzerland.
| | - N Demartines
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Bugnon 46, 1011, Lausanne, Switzerland
| | - D Clerc
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Bugnon 46, 1011, Lausanne, Switzerland
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Fukunaga T, Kasanami T. Single-incision laparoscopic repair for an arcuate line hernia: a case report. Surg Case Rep 2021; 7:196. [PMID: 34448025 PMCID: PMC8390624 DOI: 10.1186/s40792-021-01281-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 08/22/2021] [Indexed: 11/22/2022] Open
Abstract
Background The arcuate line is the inferior margin of the posterior layer of rectus abdominis sheath. An arcuate line hernia is a parietal interstitial hernia consisting of ascending protrusion of intraperitoneal contents above the arcuate line. Arcuate line hernias are rare, and fewer than 20 cases undergoing surgical repair have been reported. Various surgical approaches were used in previous cases, and there is no consensus regarding the ideal repair method. We report the first case of an arcuate line hernia repaired using single-incision laparoscopic surgery. Case presentation The patient was a 78-year-old man who presented with a history of intermittent lower abdominal quadrant pain of more than 2 month’s duration. He had not previously undergone abdominal surgery, but had a history of mycobacterial lung disease and asthma. His vital signs were normal on presentation, and he experienced no vomiting or nausea. On palpation, his abdomen was flat and soft, and no mass was palpable. However, there was slight tenderness in the right lower quadrant. Blood laboratory test results were within normal ranges. Computed tomography revealed small bowel protrusion between the rectus abdominis and the posterior rectus sheath, and an arcuate line hernia was suspected and subsequently confirmed intraoperatively. The patient underwent single-incision laparoscopic repair with the intraperitoneal onlay mesh technique with tacks and with care to avoid the inferior epigastric vessels. The operation time was 30 min, and no intra- or post-operative complications occurred. Surgery relieved his symptoms, with no recurrence within 1 year postoperatively. Conclusions Single-incision laparoscopic surgery was performed easily and successfully in this rare patient with arcuate line hernia. Arcuate line hernia should be considered in patients presenting with abdominal symptoms, and single-incision laparoscopic repair should be considered for repair.
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Affiliation(s)
- Tomohiko Fukunaga
- Department of Surgery, Sonobe Hospital, 5-8-7 Misono-cho, Sonobe-cho, Nantan, Kyoto, 622-0002, Japan.
| | - Toshihiko Kasanami
- Department of Surgery, Sonobe Hospital, 5-8-7 Misono-cho, Sonobe-cho, Nantan, Kyoto, 622-0002, Japan
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8
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A Systematic Review of the Evolution of Surgical Technique for Spigelian Hernia. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02580-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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9
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Ndong A, Tendeng JN, Niang FG, Diao ML, Diallo AC, Ndichout A, Dia DA, Nyemb PMM, Konaté I. Strangulated spigelian hernia with necrosis of the caecum, appendix and terminal ileum: an unusual presentation in the elderly. J Surg Case Rep 2020; 2020:rjaa115. [PMID: 32617146 PMCID: PMC7316440 DOI: 10.1093/jscr/rjaa115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/07/2020] [Indexed: 11/23/2022] Open
Abstract
Spigelian hernia is a rare form of abdominal wall hernias. We report an unusual case of a strangulated spigelian hernia with necrotic contents of the caecum, appendix and terminal ileum in the elderly. An 84-year-old woman, with a history of eight pregnancies, was admitted for bowel obstruction evolving for 7 days. The computed tomography scan showed a strangulated right spigelian hernia. Surgical exploration with an incision centered on the mass confirmed the diagnosis with extensive necrosis of the caecum, appendix and 10 cm of the terminal ileum. A right hemi-colectomy with an ileo-colic anastomosis was performed. The post-operative course was marked by the death of the patient in intensive care due to multi-visceral failure. The occurrence of strangulation with necrosis of the caecum, appendix and terminal ileum in spigelian hernia is extremely rare. It requires early diagnosis and treatment to reduce post-operative morbidity and mortality.
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Affiliation(s)
| | | | | | | | | | - Aicha Ndichout
- Department of Radiology, Saint-Louis Hospital, Saint-Louis, Senegal
| | - Diago Anta Dia
- Department of Surgery, Gaston Berger University, Saint-Louis, Senegal
| | | | - Ibrahima Konaté
- Department of Surgery, Gaston Berger University, Saint-Louis, Senegal
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10
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Henriksen NA, Kaufmann R, Simons MP, Berrevoet F, East B, Fischer J, Hope W, Klassen D, Lorenz R, Renard Y, Garcia Urena MA, Montgomery A. EHS and AHS guidelines for treatment of primary ventral hernias in rare locations or special circumstances. BJS Open 2020; 4:342-353. [PMID: 32207571 PMCID: PMC7093793 DOI: 10.1002/bjs5.50252] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 11/26/2019] [Indexed: 01/11/2023] Open
Abstract
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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Affiliation(s)
- N A Henriksen
- Department of Surgery, Zealand University Hospital, Koege, Denmark
| | - R Kaufmann
- Erasmus University Medical Centre, Rotterdam, the Netherlands.,Tergooi, Hilversum, the Netherlands
| | - M P Simons
- Department of Surgery, OLVG Hospital, Amsterdam, the Netherlands
| | - F Berrevoet
- Department of General and Hepato-Pancreato-Biliary Surgery, Gent University Hospital, Gent, Belgium
| | - B East
- Third Department of Surgery, Motol University Hospital, Prague, Czech Republic.,First and Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - J Fischer
- University of Pennsylvania Health System, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania, USA
| | - W Hope
- New Hanover Regional Medical Center, Wilmington, North Carolina, USA
| | - D Klassen
- Department of Surgery, Dalhousie University, Halifax, Canada
| | - R Lorenz
- Praxis 3+CHIRURGEN, Berlin, Germany
| | - Y Renard
- Department of Digestive Surgery, Robert Debré University Hospital, Reims, France
| | - M A Garcia Urena
- Henares University Hospital, Faculty of Health Sciences, Francisco de Vitoria University, Madrid, Spain
| | - A Montgomery
- Department of Surgery, Lund University, Skåne University Hospital, Malmö, Sweden
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Abstract
PURPOSE Spigelian hernias (SHs) account for 1% to 2% of abdominal wall hernias. Traditionally they have been repaired using an open technique. Since 1992, laparoscopic methods have become increasingly popular with various techniques being described in the literature. This systematic review aims to represent the current trends in laparoscopic repair of SHs. MATERIALS AND METHODS The databases MEDLINE and EMBASE were searched for appropriate terms regarding SH repair. Papers describing laparoscopic repair of SH were included. RESULTS Fifty articles were identified for the final review. No randomized controlled trials comparing laparoscopic techniques were identified. Two hundred thirty-seven SHs were repaired by various techniques. Intraperitoneal onlay mesh technique was the most popular repair method with minimal complications and recurrences reported in all techniques. CONCLUSIONS There are a number of laparoscopic techniques available to the surgeon repairing a SH. Overall, laparoscopic repair of the SH is a safe and acceptable method.
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12
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Kılıç MÖ, Değirmencioğlu G, Dener C. A rare case of Spigelian hernia combined with direct and indirect inguinal hernias. Turk J Surg 2015; 33:40-42. [PMID: 28740948 DOI: 10.5152/ucd.2015.2793] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 10/05/2014] [Indexed: 11/22/2022]
Abstract
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.
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Affiliation(s)
- Murat Özgür Kılıç
- Department of General Surgery, Turgut Özal University School of Medicine, Ankara, Turkey
| | - Gürkan Değirmencioğlu
- Department of General Surgery, Turgut Özal University School of Medicine, Ankara, Turkey
| | - Cenap Dener
- Department of General Surgery, Turgut Özal University School of Medicine, Ankara, Turkey
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13
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Polistina FA, Garbo G, Trevisan P, Frego M. Twelve years of experience treating Spigelian hernia. Surgery 2015; 157:547-50. [PMID: 25656692 DOI: 10.1016/j.surg.2014.09.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 09/09/2014] [Accepted: 09/19/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND AIMS A Spigelian hernia (SH) is an acquired ventral hernia that most commonly occurs in the Spigelian belt. Patients may experience pain or a bulge in the abdominal area, but in most cases there are no symptoms. If left untreated the hernia may become strangulated, which could lead to bowel obstruction. MATERIAL AND METHODS We reviewed 28 surgical patients with SH between January 2002 and December 2013. We evaluated the incidence of complications, recurrences, and the length of hospital stay with comorbidities, body mass index, clinical presentation, and operative techniques. RESULTS The 28 patients included 10 males and 18 females, with a mean age of 67 years. Seven patients (26.9%) received emergency operations, and the remaining patients received elective operations. An "open-direct" operative approach was used in 16 cases and a laparoscopic approach in 12. The overall complication rate was 7.6% and the recurrence rate was 3.8% with a median follow-up of 3 years. The median hospital stay was 1 day (range, 1-7). Only the presence of local complications at diagnosis showed a significant impact on length of hospital stay. None of the considered variables had a significant impact on hernia recurrence. CONCLUSION No differences were noted among the operative techniques, wound infections, complications rate, and length of hospital stay. Laparoscopy seems to cause more early postoperative pain that reverses in about 2 weeks.
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Affiliation(s)
| | - Greta Garbo
- School of Surgery, Padua University, Padua, Italy
| | - Paolo Trevisan
- Department of Surgery, Centro Oncologico Fiorentino, Florence, Italy
| | - Mauro Frego
- Department of General Surgery, Monselice Hospital, Monselice, Italy
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Changes in the frequencies of abdominal wall hernias and the preferences for their repair: a multicenter national study from Turkey. Int Surg 2014; 99:534-42. [PMID: 25216417 PMCID: PMC4253920 DOI: 10.9738/intsurg-d-14-00063.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Abdominal wall hernias are a common problem in the general population. A Western estimate reveals that the lifetime risk of developing a hernia is about 2%. As a result, hernia repairs likely comprise the most frequent general surgery operations. More than 20 million hernias are estimated to be repaired every year around the world. Numerous repair techniques have been described to date however tension-free mesh repairs are widely used today because of their low hernia recurrence rates. Nevertheless, there are some ongoing debates regarding the ideal approach (open or laparoscopic), the ideal anesthesia (general, local, or regional), and the ideal mesh (standard polypropylene or newer meshes).
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15
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Barnes TG, McFaul C, Abdelrazeq AS. Laparoscopic Transabdominal Preperitoneal Repair of Spigelian Hernia—Closure of the Fascial Defect Is Not Necessary. J Laparoendosc Adv Surg Tech A 2014; 24:66-71. [DOI: 10.1089/lap.2013.0407] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Thomas G. Barnes
- Colorectal Unit, Department of Surgery, Warrington & Halton Hospitals NHS Foundation Trust, Warrington, United Kingdom
| | - Chris McFaul
- Colorectal Unit, Department of Surgery, Warrington & Halton Hospitals NHS Foundation Trust, Warrington, United Kingdom
| | - Ayman S. Abdelrazeq
- Colorectal Unit, Department of Surgery, Warrington & Halton Hospitals NHS Foundation Trust, Warrington, United Kingdom
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16
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Ngabou U, Owono Mbouengou JP, Nyamastiengui H, Nguema Mve R, Nguema Edzang B, Tchoua R. Spigelian hernia treated by laparoscopy. J Visc Surg 2013; 150:353-4. [DOI: 10.1016/j.jviscsurg.2013.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Siosaki MD, Costa MMHC, Figueiredo HF, da Silva Junior MF, da Silva Junior RA. A differential diagnosis in chronic lower abdominal pain. Int J Surg Case Rep 2012; 3:504-6. [PMID: 22858791 DOI: 10.1016/j.ijscr.2012.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Revised: 06/07/2012] [Accepted: 06/08/2012] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION Spigelian hernias represent 0.12-2.4% of all abdominal wall hernias. Its diagnosis is elusive and requires a high level of conjecture given the disease rarity, vague associated abdominal complaints and frequent lack of consistent physical findings. PRESENTATION OF CASE A 60-year-old woman presented with a history of chronic pain in the left lower side of the abdomen. The patient was treated for several diseases with no relief of symptoms. Abdominal ultrasound showed a Spigelian hernia in the lower left abdomen and surgery was scheduled for treatment. DISCUSSION A SH is generally an inter-parietal hernia, meaning that the pre-peritoneal fat and the hernia sac penetrate the trasnversus abdominis and internal oblique muscles but remain behind the external oblique aponeurosis. In most of the patients the lack of clinical signs demands radiological investigation. That's the importance of the high grade of suspicious of the disease during the physical exam. The surgical repair is necessary due to the high risk of incarceration-related complications which can occur in up to 21% of cases. CONCLUSION It's important to think in the Spigelian hernia as cause of lower abdominal pain to prompt indicate surgical repair and provide the patient's symptom relief. Also the type of repair is dependent on the surgeon's choice and also the means available in each center.
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Affiliation(s)
- Marcos Duarte Siosaki
- General Surgery Medical Resident, Getúlio Vargas' University Hospital, Manaus, Amazonas, Brazil
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Perrakis A, Velimezis G, Kapogiannatos G, Koronakis D, Perrakis E. Spigel hernia: a single center experience in a rare hernia entity. Hernia 2012; 16:439-44. [DOI: 10.1007/s10029-012-0925-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Accepted: 05/11/2012] [Indexed: 11/29/2022]
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Moszkowicz D, Paye F, Balladur P, Lefevre JH. [A rare cause of acute small bowel obstruction: incarcerated Spieghelian hernia. Case-report and literature review]. Morphologie 2012; 96:12-5. [PMID: 22445528 DOI: 10.1016/j.morpho.2012.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A 73-year-old man, who previously underwent laparotomy for pancreatic adenocarcinoma, was admitted in the emergency room for acute small bowel obstruction related to a strangulated Spieghelian hernia. On CT-scan, the hernia was located at the lateral border of the right rectus abdominis muscle below the external oblique muscle, among the transverse abdominis and internal oblique muscles layers. Spieghelian hernias (or hernia of the linea semilunaris) often occur at the level of a weak spot where the linea accurata crosses the linea semilunaris, when the posterior layer of the rectus gain changes its conformation. This weak spot is limited underneath by the inferior epigastric artery. When examining a patient with a previous history of laparotomy presenting with acute small bowel obstruction, it is mandatory to exclude a possible strangulated Spieghelian hernia before concluding to postoperative intra-abdominal adhesions. Spieghelian hernias are asymptomatic in approximately 90% of cases but entail a high risk of strangulation. Consequently, herniorrhaphy through a local approach route or open/laparoscopic mesh repair is always required.
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Affiliation(s)
- D Moszkowicz
- Département de chirurgie digestive, hôpital Saint-Antoine, Assistance publique-Hôpitaux de Paris, France
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Bittner JG, Edwards MA, Shah MB, Macfadyen BV, Mellinger JD. Mesh-Free Laparoscopic Spigelian Hernia Repair. Am Surg 2008. [DOI: 10.1177/000313480807400808] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Varied Spigelian hernia mesh repair techniques have been described, although evidence suggests laparoscopy results in less morbidity and shorter hospitalization compared with open procedures. Laparoscopic suture repair of Spigelian hernias is rarely reported. Two patients with small Spigelian hernias (≤2 cm) were diagnosed and repaired laparoscopically using a transabdominal suture technique. Under laparoscopic guidance, a suture-passer was used to place two or three transfacial, interrupted 0 polypropylene sutures along the horizontal plane of the defect. Sutures were tied extracorporeally and closure was confirmed laparoscopically. These cases spurred a review of world literature (2001–2007) including clinical characteristics, operative techniques, and urgency of operations in Spigelian hernia patients. Data were compared using Fisher's exact test. One year postoperatively, the patients are without sequelae or recurrence. Literature review demonstrated most patients were females ( P < 0.001), ranged in age from 60 to 80 years ( P = 0.042), and presented with left-sided hernias ( P = 0.026). Open mesh repair (182/392 cases; 47%) was the most common technique; however, increasingly articles describe laparoscopic mesh repair. Mesh-free laparoscopic suture repair is feasible and safe. This novel uncomplicated approach to small Spigelian hernias combines the benefits of laparoscopic localization, reduction, and closure without the morbidity and cost associated with foreign material.
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Affiliation(s)
- James G. Bittner
- From the Section of Gastrointestinal Surgery, Department of Surgery, Medical College of Georgia School of Medicine, Augusta, Georgia
| | - Michael A. Edwards
- From the Section of Gastrointestinal Surgery, Department of Surgery, Medical College of Georgia School of Medicine, Augusta, Georgia
| | - Malay B. Shah
- From the Section of Gastrointestinal Surgery, Department of Surgery, Medical College of Georgia School of Medicine, Augusta, Georgia
| | - Bruce V. Macfadyen
- From the Section of Gastrointestinal Surgery, Department of Surgery, Medical College of Georgia School of Medicine, Augusta, Georgia
| | - John D. Mellinger
- From the Section of Gastrointestinal Surgery, Department of Surgery, Medical College of Georgia School of Medicine, Augusta, Georgia
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Abstract
Primary ventral hernias can be congenital or acquired, but are not associated with a fascial scar or related to a trauma. Some ventral hernias such as Spigelian, lumbar, or obturator hernias represent a diagnostic challenge, given their relative rarity and their unusual anatomic locations. The article presents the etiology, clinical presentation, and diagnosis of these hernias, and briefly describes the various surgical approaches, including open and laparoscopic.
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