Transverse CT image of the abdomen in a patient with a Spigelian hernia (arrow).
|Classification and external resources|
A Spigelian hernia (or lateral ventral hernia) is a hernia through the spigelian fascia, which is the aponeurotic layer between the rectus abdominis muscle medially, and the semilunar line laterally. There is a common misconception that they protrude below the arcuate line owing to deficiency of the posterior rectus sheath at that level, but in fact the defect is almost always above the arcuate line. These are generally interparietal hernias, meaning that they do not lie below the subcutaneous fat but penetrate between the muscles of the abdominal wall; therefore, there is often no notable swelling.
Symptoms and diagnosis
Patients typically present with either an intermittent mass, localized pain, or signs of bowel obstruction. Ultrasonography or a CT scan can establish the diagnosis, although CT scan provides the greatest sensitivity and specificity.
These hernias should be repaired because of the high risk of strangulation; fortunately, surgery is straightforward, with only larger defects requiring a mesh prosthesis. Varied Spigelian hernia mesh repair techniques have been described, although evidence suggests laparoscopy results in less morbidity and shorter hospitalization compared with open procedures. Mesh-free laparoscopic suture repair is feasible and safe. 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.
Raveenthiran described a new syndrome in which spigelian hernia and cryptorchidism (undescended testis) occur together (Ref: Raveenthiran V. Congenital Spigelian hernia with cryptorchidism: probably a new syndrome. Hernia. 2005 Dec;9(4):378-80. Epub 2005 Mar 22. PubMed PMID 15782280.)
- Larson DW, Farley DR (2002). "Spigelian hernias: repair and outcome for 81 patients". World journal of surgery 26 (10): 1277–81. doi:10.1007/s00268-002-6605-0. PMID 12205553.
- Bittner JG, Edwards MA, Shah MB, MacFadyen BV, Mellinger JD (August 2008). "Mesh-free laparoscopic spigelian hernia repair". Am Surg 74 (8): 713–20; discussion 720. PMID 18705572.
- Vos DI, Scheltinga MR (2004). "Incidence and outcome of surgical repair of spigelian hernia". The British journal of surgery 91 (5): 640–4. doi:10.1002/bjs.4524. PMID 15122618.