The advantage of laparoscopic surgery in the treatment of Spigelian hernia: A report of two cases

Abstract

Introduction and importance The usefulness of laparoscopic surgery in the treatment of Spigelian hernias and the appropriate insufflation pressure remains unclear. Case presentation Case 1 involved an 81-year-old woman presented with a right abdominal protrusion. CT scan demonstrated a defect in the abdominal wall at the lateral edge of the right rectus abdominis muscle. We diagnosed as Spigelian hernia and performed laparoscopic hernia repair. The insufflation pressure was set at 10 cm H 2 O, and the IPOM method was selected as the repair method. Case 2 involved a 74-year-old male presented with a right abdominal painful bulging. Strangulation was released and CT scan demonstrated a defect in the abdominal wall at the lateral edge of the right rectus abdominis muscle. We diagnosed as Spigelian hernia and performed laparoscopic hernia repair. The insufflation pressure was set at 10 cmH 2 O, and the repair was performed by the hybrid method. Clinical discussion In both cases, the positions of the hernia portals marked preoperatively based on the tender areas and confirmed laparoscopically were not accurate. Although Spigelian hernia is a rare disease and various laparoscopic techniques have been reported in recent years, laparoscopic surgery is very useful to obtain an accurate diagnosis and to observe the abdominal wall from inside the abdominal cavity under insufflation, and it is better to decide the repair method according to the situation of each case and institution. Conclusion Laparoscopic surgery is important for accurate diagnosis in surgery of Spiegel's hernia, and insufflation pressure of 10 cmH2O was sufficient.

Recurrent Spigelian Hernia: case report

“…Even though it is rare, Spiegel's hernia is a diagnosis that must be kept in mind when investigating abdominal wall hernias. Predisposing factors include aging, previous surgery, and increased intra-abdominal pressure secondary to obesity, multiparity, ascites, chronic cough, and chronic obstructive pulmonary disease, among others [3,5]. In this report, we describe the case of a patient in her 50th decade of life, obese, multiparous (two cesarean deliveries), and with a previous hysterectomy, which corroborates the literature.…”

“…Affected individuals may be asymptomatic or present with pain and a palpable mass in the anterolateral region of the abdomen [1,6], as occurred in this case. Imaging tests such as ultrasound and computed tomography are useful for diagnostic confirmation [3].…”

“…Spiegel's hernia is a rare type of abdominal wall hernia, which incidence ranges from 0.12 to 2% of all abdominal hernias [1,2]. It is characterized by the protrusion of adipose tissue, peritoneal sac or abdominal viscera between the semilunar line and the lateral border of the rectus abdominis muscle [2,3]. The most affected age group is from 40 to 70 years and the distribution of the disease is similar in both genders [1], although a small female predilection has been described [4].…”

Anterior abdominal wall swelling as incarcerated Spigelian hernia in an elderly female: A diagnostic dilemma

“…Faster recovery, shorter hospital stays, and lower morbidity render the laparoscopic approach superior to the open approach [17] . According to recent European Hernia Society (EHS) guidelines, mesh repair is recommended regardless of the approach to reduce recurrence [ 18 , 19 ]…”

Non-strangulated Spigelian Hernia: A Case Report

“…Although there are no clear guidelines favoring one technique over the other, the most popular approach is IPOM due to its ease of learning and safety advantages [ 8 ]. According to recent European Hernia Society (EHS) guidelines, mesh repair is recommended regardless of whether an open or laparoscopic approach is selected, as it offers a low rate of recurrence [ 14 , 15 ]. A variation of the IPOM technique is the IPOM-plus, the surgical method chosen for our patient.…”