| Spigelian hernia | |
|---|---|
| Other names | Lateral ventral hernia |
 | |
| Transverse CT image of the abdomen in a patient with a Spigelian hernia (arrow). | |
| Specialty | General surgery |
ASpigelian hernia is the type ofventral hernia that occurs through the Spigelian fascia, which is the part of theaponeurosis of thetransverse abdominal muscle bounded by thelinea semilunaris (or Spigelian line) laterally and the lateral edge of therectus abdominis muscle medially.[1][2]
It is the protuberance ofomentum,adipose tissue, orbowel in that weak space between the abdominal wall muscles, that ultimately pushes theintestines or superficialfatty tissue through a hole causing a defect. As a result, it creates the movement of an organ or a loop of intestine in the weakened body space that it is not supposed to be in. It is at this separation (aponeurosis) in theventral abdominal region, thatherniation most commonly occurs.
Spigelianhernias are rare compared to other types of hernias because they do not develop under abdominal layers of fat but between fascia tissue that connects tomuscle. The Spigelian hernia is generally smaller in diameter, typically measuring 1–2 cm., and the risk of tissue becomingstrangulated is high.
Individuals typically present with either intermittent pain, a lump or mass, all which are classic signs of abowel obstruction.[3] The patient may have a protuberance when standing in an upright position although discomfort can sometimes be confused by its anatomical region for apeptic ulceration.[4] The bulge may be painful when the patient stretches but then goes away when they are lying down in a resting position.[5] However, a number of patients present with no obvious symptoms but vague tenderness along the area in which the Spigelian fascia is located.[6]
Ultrasound Imaging or aCT scan will provide better imaging for the detection of a hernia than anX-ray.[7] Theultrasound probe should move from lateral to medially, ahypoechoic mass should appearanteriorly and medially to theinferiorepigastricartery duringValsalva maneuver.[8] The diagnosis of a Spigelian hernia is traditionally difficult if only given a history andphysical examination.[9] People who are good candidates forelective Spigelianhernia surgery, after receiving an initial diagnostic consultation by alicensed medical professional, will be advised to see a physician to schedule surgery.
The Spigelian hernia can be repaired by either anopen procedure orlaparoscopic surgery because of the high risk ofstrangulation.[10] Surgery is straightforward, with only larger defects requiring amesh prosthesis. In contrast to the laparoscopic intraperitoneal onlay mesh plan of action there is a significant higher risk associated with complications and recurrence rates during the period following a surgical operation.[11] A Spigelian hernia becomes immediately operative once the risk of incarceration is confirmed.[citation needed] Today, a Spigelian hernia can be repaired by doingrobotic laparoscopy and most patients aredischarged on the same day. This novel, uncomplicated approach to small Spigelian hernias combines the benefits of laparoscopic localization, reduction, and closure without themorbidity and cost associated with foreign material.[12] Mesh-free laparoscopicsuture repair is an uncomplicated approach to small Spigelian hernias combined with the benefits of a closure without the anguish and cost associated with foreign material.[7][13]
Adriaan van den Spiegel was ananatomist at theUniversity of Padua during the 17th century. He became a professor of surgery in 1619 and was the first to describe this rarehernia in 1627.[14] The history of the Spigelian hernia was acknowledged in 1645, twenty years after Spiegel's death. In 1764, almost a century later, theFlemish anatomist,Josef Klinkosch, was acknowledged for recognizing and describing a hernia located in the Spigelianfascia, and coined the term Spigelian hernia.[15]
Raveenthiran described a new syndrome in which Spigelian hernia andcryptorchidism (undescendedtestis) occur together.[16] Some common complications of this distinct syndromecryptorchidism aretesticular torsion, and its link totesticular cancer.[17]
