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      Laparoscopic Transabdominal Preperitoneal Repair of Spigelian Hernia

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          Abstract

          Background:

          A Spigelian hernia is a congenital defect in the transversus aponeurosis fascia. Traditionally, an anterior hernioplasty was used to repair these defects. This study aimed to document our experience with laparoscopic transabdominal preperitoneal repair for Spigelian hernia.

          Methods:

          Eight patients underwent laparoscopic transabdominal Spigelian hernia repair. All patients underwent creation of a peritoneal flap, sac dissection, identification and approximation of the fascial defect, mesh reinforcement, and reperitonealization.

          Results:

          All patients presented with pain. An intermittent palpable mass was noticed in 4 patients. One third of the patients had undergone prior surgery and none had an incisional hernia. Only 1 patient presented with severe pain for 1 day; however, there was no bowel strangulation intraoperatively. All patients underwent laparoscopic transabdominal preperitoneal repair. No postoperative complications occurred. There have been no recurrences at a mean follow-up of 41 months (range, 8 to 96).

          Conclusion:

          Laparoscopic transabdominal preperitoneal repair of Spigelian hernia is safe, easy, and feasible for experienced laparoscopic surgeons.

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          Most cited references12

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          Spigelian hernias: repair and outcome for 81 patients.

          Keith Larson, Roger D Farley (2002)
          Spigelian hernia is a rare partial abdominal wall defect. The frequent lack of physical findings along with vague associated abdominal complaints makes the diagnosis elusive. A retrospective review of Mayo Clinic patients was performed to find all patients who had undergone surgical repair of a Spigelian hernia from 1976 to 1997. Patients were scrutinized for presentation, work-up, therapy, and outcome. The goal of this study was to obtain long-term outcome. The study was set in a tertiary referral center. There were 76 patients in whom 81 Spigelian hernias were repaired. Symptoms most commonly included an intermittent mass (n = 29), pain (n = 20), pain with a mass (n = 22), and bowel obstruction (n = 5). Five patients were asymptomatic. Preoperative imaging was performed in 21 patients and correctly diagnosed the hernia in 15. Spigelian hernias were repaired by primary suture closure (n = 75), mesh (n = 5), and laparoscopic (n = 1) techniques. Eight patients (10%) required emergent operations. Thirteen hernias (17%) were found to be incarcerated at the time of the operation. Overall mean follow-up for the 76 patients was 8 years, with three hernia recurrences identified. Spigelian hernia is rare and requires a high index of suspicion given the lack of consistent symptoms and signs. An astute physician may couple a proper history and physical examination with preoperative imaging to secure the diagnosis. Mesh and laparoscopic repairs are viable alternatives to the durable results of standard primary closure. Given the high rate of incarceration/strangulation, the diagnosis of Spigelian hernia is an indication for surgical repair.
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            Incidence and outcome of surgical repair of spigelian hernia.

            Dagmar I Vos, M Scheltinga (2004)
            A spigelian hernia develops through a defect present in a locus minoris resistentiae between abdominal muscles. It is generally considered rare but is probably underdiagnosed. This study was undertaken to characterize the history, presenting features and efficacy of surgical correction of spigelian hernia. Medical and surgical charts of 25 patients treated for a spigelian hernia over 22 years were studied retrospectively. Patients were invited for an outpatient interview and physical examination. Dominant symptoms were an intermittent palpable mass (22 patients) and postural pain (16). A quarter of the patients reported a history of other hernias. Two individuals presented with a painful palpable mass and signs of bowel obstruction necessitating emergency small bowel resection. Hernia repair was performed by primary closure in 20 patients and by use of mesh graft in five. During a mean follow-up of 6.1 years, one early recurrence was observed. Two patients reported mild tenderness in the operated area but were not impaired in daily activities. Spigelian hernia is commonly encountered and requires surgical treatment because of the risk of strangulation. Operative treatment is simple and effective in the long term. Copyright 2004 British Journal of Surgery Society Ltd.
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              Spigelian hernia.

              L Spangen (2015)
              The diagnosis of spigelian hernia presents greater difficulties than its treatment. The clinical presentation varies, depending on the contents of the hernial sac and the degree and type of herniation. The pain, which is the most common symptom, varies and there is no typical pain of spigelian hernia. Findings to facilitate diagnosis are palpable hernia and a palpable hernial orifice. Large, easily palpable spigelian hernias are not a diagnostic problem. It is small hernias and hernial orifices that are overlooked because they are masked by the subcutaneous fat and an intact external aponeurosis. In the absence of a palpable orifice or sac, persistent point tenderness in the spigelian aponeurosis with a tensed abdominal wall most strongly suggests the diagnosis. Spigelian hernia can be ruled out in patients without palpable tenderness. Ultrasonic scanning can be recommended for verification of the diagnosis in both palpable and nonpalpable spigelian hernia. The hernial orifice and sac can also be demonstrated by computed tomography, which gives more detailed information on the contents of the sac than does ultrasonic scanning. The treatment of spigelian hernia is surgical, and the risk of recurrence is small. A gridiron incision is excellent for operations for palpable hernias. If the hernia cannot be palpated preoperatively, preperitoneal dissection through a vertical incision is recommended. This gives good exposure, facilitates hernioplasty, and permits preperitoneal exploration and treatment of other abdominal wall hernias. The incision is also suitable for exploratory laparotomy, which should be performed on patients with abnormal ultrasonographic or computed tomographic findings in whom no palpable hernia can be detected preoperatively.
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                Author and article information

                Journal
                Journal ID (nlm-ta): JSLS
                Journal ID (iso-abbrev): JSLS
                Journal ID (hwp): jsls
                Journal ID (pmc): jsls
                Journal ID (publisher-id): JSLS
                Title: JSLS : Journal of the Society of Laparoendoscopic Surgeons
                Publisher: Society of Laparoendoscopic Surgeons (Miami, FL )
                ISSN (Print): 1086-8089
                ISSN (Electronic): 1938-3797
                Publication date (Print): Apr-Jun 2006
                Volume: 10
                Issue: 2
                Pages: 193-198
                Affiliations
                Coimbatore, Tamil Nadu, India.
                Author notes
                Address reprint requests to: Chinnaswamy Palanivelu, GEM Hospital, 45-A, Pankaja Mill Road, Ramanathapuram, Coimbatore, Tamil Nadu, India 641045. Telephone 91 422 2324100/01/02, Fax: 91 422 2320879, E-mail: p@ 123456gemhospital.net
                Article
                PMC ID: 3016144
                PubMed ID: 16882419
                SO-VID: c3982e76-b7ea-4776-ba0f-becce42498c1
                Copyright © © 2006 by JSLS, Journal of the Society of Laparoendoscopic Surgeons.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License ( http://creativecommons.org/licenses/by-nc-nd/3.0/), which permits for noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited and is not altered in any way.

                History
                Categories
                Subject: Scientific Papers

                ScienceOpen disciplines: Surgery
                Keywords: preperitoneal repair,adults,laparoscopy,spigelian hernia
                Data availability:
                ScienceOpen disciplines: Surgery
                Keywords: preperitoneal repair, adults, laparoscopy, spigelian hernia

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