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 is the type of ventral hernia where aponeurotic fascia pushes through a hole in the junction of thelinea semilunaris and thearcuate line creating a bulge. It appears in the abdomen lower quadrant between an area of dense fibrous tissue and abdominal wall muscles causing a (Spigelianaponeurosis).^[1]

It is the protuberance, of omentum, adipose tissue, or bowel in that weak space between the abdominal wall muscles, that ultimately pushes the intestines or superficial fatty 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 the ventral abdominal region, that herniation 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 to muscle. The Spigelian hernia is generally smaller in diameter, typically measuring 1–2 cm., and the risk of tissue becoming strangulated is high.

Raveenthiran syndrome (Spigelian-cryptorchidism syndrome), Raveenthiran described a new syndrome in which Spigelian hernia andcryptorchidism (undescended testis) occur together.^[2] Some common complications of this distinct syndromecryptorchidism aretesticular torsion, and its link to testicular cancer.^[3]

Signs and symptoms

Individuals typically present with either intermittent pain (coming and going), a lump, or mass all which are classic signs of abowel obstruction.^[4] 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.^[5] The bulge may be painful when the patient stretches but then goes away when they are lying down in a resting position.^[6] However, a number of patients present with no obvious symptoms but vague tenderness along the area in which the Spigelian fascia is located.^[7]

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  Image of the individual's abdomen with a Spigelian hernia

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  Hernia spiegheli

Cause

The etiology of Spigelian hernia can be due to the following:^[8]

• Underlying pathology
• Abdominal trauma
• Collagen synthesis disorder

Diagnosis

Ultrasound Imaging or a CT Scan will provide better imaging for the detection of a hernia than an xray.^[9] The ultrasound probe should move from lateral to medially, a hypoechoic mass should appear anteriorly and medially to the inferior epigastric artery duringValsalva maneuver.^[10] The diagnosis of a Spigelian hernia is traditionally difficult if only given a history and physical examination.^[11] People who are good candidates for elective Spigelianhernia surgery, not only but also, after receiving an initial diagnostic consultation by a licensed medical professional, will be advised to see a physician to schedule surgery.

Treatment

The Spigelian hernia can be repaired by either an open procedure or laparoscopic surgery because of the high risk of strangulation;^[12] 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.^[13] 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 can go home 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.^[14] Mesh-free laparoscopic suture 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.^[9]

Eponym

Adriaan van den Spiegel, born inBrussels, was ananatomist at theUniversity of Padua during the 17th century. In 1619 he became a professor of surgery. Spiegel was the first to described this rare hernia in 1627.^[15] The history of the Spigelian hernia became 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.^[16]

References

External links

• Adriaan van den Spiegel atWho Named It?
• Laparoscopic Repair of Spigelian HerniaArchived 2022-05-24 at theWayback Machine Medtube

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