Spigelian Hernia: Case Series and Review of the Literature

Abstract

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.

Incarcerated Spigelian Hernias: A Rare Cause of a High-grade Small Bowel Obstruction

“…The hernial sac is typically intraparietal, passing through the transversus and internal oblique aponeuroses and extending out beneath the external oblique or within the rectus sheath [1]. The reported literature shows that hernia usually consists of preperitoneal fat [6]. However, the hernia may contain small bowel, colon, omentum, or occasionally, the appendix [7][8].…”

“…Most authors suggest repairing the Spigelian hernia as the fascia here typically forms a rigid neck which could lead to future incarceration or strangulation. The reported incidence of incarceration is between 24% -27% and strangulation at 2% -14% [6].…”

Rare Presentations of Hernia

“…Spigelian hernia occurs due to a weakness of the spigelian fascia, which is the layer between rectus muscle and semilunar line [3]. The absence of a posterior rectus sheath is a contributing factor at this location and therefore mostly occurs below the arcuate line.…”

Laparoscopic Rare Abdominal Hernia Treatment

“…A MEDLİNE search of the published literature shown that 232 cases in which the results of SH patients operated between 1997 and 2017 were evaluated; the most common choice was IPOM 32%, TEP 30%, and TAPP 22%. In laparoscopic mesh repair, onlay mesh, mesh extended to the retrorectus cavity, mesh repair placed in the extraperitoneal space were defined at the largest case series of 107 cases of laparoscopic repair which was published by Weber et al [17]. The risk of neurovascular injury in the posterolateral abdominal wall due to the tacker usage for abdominal wall fixation of these meshes is reported to be higher in IPOM and TAPP operations.…”