Spigelian hernia

A Spigelian or lateral ventral hernia is a type of hernia that protrudes through the spigelian fascia, and appears in the lower quadrant of the abdomen between the abdominal musculature region of the Spigelian aponeurosis. ^[1] It is the protrusion of bowel or tissue to a weak area in the abdominal wall muscles, that ultimately pushes on fatty tissue creating a bulge through a hole in the abdominal muscles, causing a defect. As a result it creates the movement of an organ or a loop of intestine into the weakened body space that it is not supposed to be in. It is at this separation aponeurosis in the ventral abdominal region, that herniation most commonly occurs. ^[2]

Spigelian hernias are different from other types of hernias; they do not typically develop under layers of fat but rather between fascia tissue that connects to muscle. Compared to other types of hernias they are rare. ^[3] The Spigelian hernia is generally smaller in diameter, typically measuring 1–2 cm. ^[4] Therefore the risk of strangulation is high.

Signs and symptoms[edit source]

People typically present with either an intermittent pain (coming and going), a mass, localized pain, or signs of bowel obstruction. ^[3] The patient may have a classic lump when standing upright and sometimes discomfort can be confused by its anatomical region for a peptic ulceration. ^[5] The lump is painful if the patient stretches and disappears on lying down. ^[6] However, a number of patients present with no obvious hernia but a vague lump or tenderness along the region of the Spigelian fascia. ^[7]

Diagnosis[edit source]

Ultrasonography or a CT scan can establish the diagnosis, although CT scan provides the greatest sensitivity and specificity. ^[8] Diagnosing Spigelian hernias is traditionally difficult if only given the history and physical examination. ^[9] Diagnosis of Spigelian hernias is complicated both by its rarity, because it accounts for only 0.12% of all hernias of the abdominal wall, and by the fact that is has no characteristic signs or symptoms. ^[6]   Considering a significant proportion of patients in non-emergent environments, most are good candidates for elective Spigelian hernia surgery, particularly after receiving an initial diagnostic and medical consultation.

Treatment[edit source]

These hernias should be repaired because of the high risk of strangulation. ^[10] Treatment of Spigelian hernia is operative repair once the diagnosis has been confirmed given the risk of incarcerated hernia. ^[11] Whereas, open surgery is straightforward, with only larger defects requiring a mesh prosthesis. There are a few ways a Spigelian hernia can be fixed such as; laparoscopy technique where an incision is made away from the hernia using endoscopic instruments to repair the hernia while watching it on a monitor screen. Today, a Spigelian hernia can be repaired by doing robotic laparoscopy and most patients can go home the same day.  While the open approach is the more classic way of treatment, laparoscopic Intraperitoneal Onlay Mesh Procedure (IPOM) has been shown to be a safe, fast, and efficient alternative. Compared to laparoscopic IPOM, the open IPOM technique was associated with significantly higher postoperative complication rates and recurrence rates. ^[12]

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. ^[8] Mesh-free laparoscopic suture repair is feasible and safe.

Eponym[edit source]

Adriaan van den Spiegel, a surgeon- anatomist born in Brussels, was one of the most prominent anatomists at the University of Padua during the 17th century and became professor of surgery there in 1619.Cite error: The opening <ref> tag is malformed or has a bad name (see the help page). Spiegel first described this hernia in 1627. ^[13] The first publication was in 1645, twenty years after Spiegel's death. Almost a century later, a Flemish anatomist, Josef Klinkosch was credited for recognizing the the Spigelian hernia in the variant of deep fascia.Cite error: The opening <ref> tag is malformed or has a bad name (see the help page).  In 1764, Klinkosh described a hernia located in the spigelian fascia and coined the term spigelian hernia. ^[14]

Raveenthiran syndrome[edit source]

Dr. Raveenthiran of SRM Hospital, Kattankulathur described a new syndrome in which Spigelian hernia and cryptorchidism ( undescended testis) occur together. ^[15] Common complications of cryptorchidism are testicular torsion, subfertility, inguinal hernia, and testicular cancer. ^[16]

References[edit source]

^[1]

External links

Wikimedia Commons has media related to Sigelian Hernia.

Video link [edit source]

Ismayilov, I. (2017). Laparoscopic Repair of Spigelian Hernia • Video • MEDtube.net. MEDtube.Net. https://medtube.net/general-surgery/medical-videos/20274-laparoscopic-repair-of-spigelian-hernia