The open mesh repair of Spigelian hernia

BACKGROUND: Spigelian hernias are rare defects of the abdominal wall usually appearing between the abdominal muscles, lateral to the rectus abdominis and through a debilitated Spigelian aponeurosis. Recently, mesh repair has been introduced for the treatment of these types of hernias and different approaches have been proposed. METHODS: Nine patients with Spigelian hernia were prospectively treated by placing a mesh prosthesis between the external oblique and the internal oblique muscles, based on principles of mesh repair established by the Lichtenstein group. RESULTS: Five women and 4 men, mean age 75.7 years, were operated on. In 1 patient the Spigelian hernia was an incidental finding during an inguinal hernia repair. Two patients were operated on an emergency basis. Elective operations were undertaken in ambulatory facilities in 3. Two patients had postoperative ecchymosis with no associated morbidity. No recurrences have been observed during follow-up. CONCLUSIONS: Open mesh repair of Spigelian hernias placing the mesh between the external and internal oblique muscles is a simple and safe approach that can prevent morbidity related to other techniques.     

Colonic obstruction secondary to incarcerated Spigelian hernia in a severely obese patient

Spigelian hernia is a rare hernia of the ventral abdominal wall accounting for 1-2% of all hernias. Incarceration of a Spigelian hernia has been reported in 17-24% of the cases. We herein describe an extremely rare case of a colonic obstruction secondary to an incarcerated Spigelian hernia in a severely obese patient. Physical examination was inconclusive and diagnosis was established by computed tomography scans. The patient underwent an open intraperitoneal mesh repair. A high level of suspicion and awareness is required as clinical findings of a Spigelian hernia are often nonspecific especially in obese patients. Computed tomography scan provides detailed information for the surgical planning. Open mesh repair is safe in the emergent surgical intervention of a complicated Spigelian hernia in severely obese patients.     

Planned totally extraperitoneal laparoscopic Spigelian hernia repair

A Spigelian hernia is a congenital defect in the tranversus aponeurosis fascia. Traditionally, an open anterior hernioplasty was used to repair these defects. Recently, laparoscopic approaches have been described. This report describes the first application of the totally extraperitoneal laparoscopic approach to a planned repair of a Spigelian hernia. The patient was a 62-year-old white female with a reducible left lower quadrant anterior abdominal wall bulge consistent with a Spigelian hernia. At the time of surgery, we exposed the posterior rectus fascia and modified our extraperitoneal inguinal hernia technique by passing the balloon dissector in a more lateral orientation. This created a unilateral preperitoneal space with adequate room for dissection and mesh fixation. The Spigelian defect was easily identified. Its preperitoneal fat contents were reduced, and a 5-mm laparoscopic tacking device was used to secure a piece of prolene mesh. The patient was discharged home with no complications. Placement of the mesh in the preperitoneal space avoids direct interaction of the mesh prosthesis and the intraperitoneal viscera. In conclusion, we find that a laparoscopic totally extraperitoneal approach is technically feasible and advantageous when a Spigelian hernia is diagnosed preoperatively.     

Incarcerated Spigelian hernia mimicking obstructing colon carcinoma

Spigelian hernia is a ventral abdominal hernia that only rarely causes incarceration or strangulation of the bowel. There are few reports in the surgical literature of colonic obstruction secondary to incarcerated Spigelian hernia. In this paper, we present a patient with an incarcerated sigmoid colon in a Spigelian hernia sac, mimicking on contrast enema an obstructing carcinoma. Accurate diagnosis was made pre-operatively by computed tomography (CT), and the hernia was repaired by polypropylene mesh in a tension-free manner.     

充填式无张力疝修补术后复发的预防

目的　探讨充填式无张力疝修补术后复发的原因及对策。方法　通过对 1 0例腹股沟斜疝病人经疝环充填式无张力疝修补术后复发情况的研究。结果　网塞和补片的放置缝合欠佳及术后存在腹内压增高因素是引起复发的主要原因。结论　减少疝环充填式无张力疝修补术后复发应改进网塞和补片的固定方法及控制腹内压增高因素     

An unusual presentation of an incarcerated Spigelian hernia

Spigelian hernias are rare hernias, occurring through a defect in the Spigelian aponeurosis. Like other hernias, they may contain abdominal contents but are more likely to be incarcerated due to the small size of the fascial defect. Multiple intra-abdominal organs have reportedly been found in Spigelian hernias. A search of the literature showed only nine reported cases in which an appendix has been found within a Spigelian hernia. We present a patient with a history of lower abdominal pain since 10 weeks with a large intra-abdominal mass in the right iliac fossa. Due to abscess formation with spontaneous evacuation through the abdominal wall, drainage and incision were performed and the patient was treated with broad-spectrum antibiotics. An explorative laparoscopy after six weeks showed an incarcerated appendix in a Spigelian hernia.     

Spigelian hernia: 3 case reports

Spigelian hernia is an uncommon hernia of the abdominal wall, often not easily diagnosed. Three cases of Spigelian hernia are reported. In the first patient it was an incidental discovery, in the second one hernia was complicated by strangulation of the small bowel, in the third patient hernia was symptomatic without complications. In all the patients, in their previous clinical history, an operation for hernia or other abdominal pathologies was observed. These patients were treated surgically, using direct reconstruction of the abdominal wall in two cases, while a non-absorbable mesh was positioned in the preperitoneal space in the third patient. The anatomopathological and clinical features of Spigelian hernia are described and the problems in diagnosis discussed; in addition, the importance of surgical cure in incidental hernia is underlined.     

Spigelian hernia associated with strangulation of the small bowel and appendix

Spigelian hernia is a rare lateral ventral abdominal hernia. These clinically elusive hernias are treacherous and have a real risk of strangulation. We present a patient with a strangulation of the small bowel and appendix in a right spigelian hernia, which was accurately demonstrated by spiral computerised tomography preoperatively and successfully treated with primary suturing reinforced with polypropylene mesh. With a high index of suspicion and the use of modern radiological technique, these "bewildering" hernias can be diagnosed and repaired relatively safely.     

Laparoscopic diagnosis and repair of Spigelian hernia: A case report and literature review

IntroductionSpigelian hernias are a rare type of hernia which protrude through the abdominal wall at the semilunar line. They are especially difficult to diagnose due to their location and non-specific symptoms and are often overlooked because of their positioning between muscular layers. Patients may present with localized pain which can aid the diagnosis. CT and ultrasound are also helpful.Presentation of case: We present the case of a 75-year-old female patient who presented to Hialeah Hospital with a one-year history of abdominal pain localized to the left lower quadrant.DiscussionA Spigelian hernia containing omentum, was found during a diagnostic laparoscopy. The hernia was reduced, and the abdominal defect was repaired via primary repair, reinforced by mesh. The patient recovered uneventfully.ConclusionNonspecific physical exam findings and inconclusive imaging studies represented a diagnostic challenge. Here we discuss a case of a Spigelian hernia discovered through diagnostic laparoscopy.     

Single-Incision Laparoscopic Repair of Spigelian Hernia

Introduction:Spigelian hernias represent only 1% to 2% of all abdominal wall hernias. The treatment, however, remains controversial but depends on institutional expertise. This case series reports the first experience with single-incision laparoscopic totally extraperitoneal (SILTEP) repair of Spigelian hernias with telescopic extraperitoneal dissection in combination with inguinal hernia repair.Methods:From February 2013 to April 2014, all patients referred with inguinal or Spigelian hernias, without histories of extraperitoneal intervention, underwent SILTEP repair with telescopic extraperitoneal dissection. A single-port device, 5.5 mm/52 cm/30° angled laparoscope, and conventional straight dissecting instruments were used for all cases. Extraperitoneal dissection was performed under direct vision with preservation of preperitoneal fascia overlying retroperitoneal nerves. Inguinal herniorrhaphy was performed with lightweight mesh that covered low-lying Spigelian defects. High-lying Spigelian defects were repaired with additional mesh.Results:There were 131 patients with 186 (92 direct) inguinal hernias and 7 patients with 8 Spigelian hernias (6 incidental, including 1 bilateral and 2 preoperatively diagnosed), with a mean age of 51.3 years and a mean body mass index of 25.1 kg/m². An additional piece of mesh was used for 3 hernias. All Spigelian hernias were associated with direct inguinal hernias, and 8 combined inguinal and Spigelian hernias were successfully repaired with SILTEP repair with telescopic extraperitoneal dissection as day cases. There were no clinical recurrences during a mean follow-up period of 6 months (range, 1–15 months).Conclusions:Combined Spigelian and inguinal hernias can be successfully treated with SILTEP herniorrhaphy with telescopic extraperitoneal dissection. The high incidence of Spigelian hernias associated with direct inguinal hernias suggests a high index of suspicion for Spigelian hernias during laparoscopic inguinal herniorrhaphy.     

Laparoscopic repair of Morgagni diaphragmatic hernia

Background: Morgagni diaphragmatic hernia is a rare congenital hernia that lies retrosternal through a congenital defect between the sternal and costal portions of the diaphragm. Surgical repair of Morgagni hernia is recommended because incarceration or strangulation of bowel within the thoracic cavity may occur. Methods: A case of Morgagni diaphragmatic hernia is presented and laparoscopic repair using Gore‐Tex DualMesh is described. Results: There was complete resolution of the patient’s symptoms including her dyspnoea. There were no postoperative complications. Conclusion: Laparoscopic repair of Morgagni diaphragmatic hernia is a safe and effective method for treating this rare surgical condition. The use of dual‐layer mesh allows tension‐free repair without the risk of intra‐abdominal adhesions forming between bowel and mesh.     

Emergency Intraperitoneal Onlay Mesh Repair of Incarcerated Spigelian Hernia

Background and Objectives:

Spigelian hernia is a rare cause of incarcerated ventral abdominal hernia that may pose a diagnostic dilemma. However, with the increasing utilization of double contrast computed tomography (CT) for undiagnosed small bowel obstruction in a virgin abdomen, more such cases are being diagnosed with increasing confidence. Furthermore, with the rapid expansion of the indications for minimal access surgery in emergency situations, these rare emergencies are increasingly tackled using a laparoscopic approach leading to swift patient recovery and discharge.

Methods:

We present the case of an emergency intraperitoneal onlay mesh (IPOM) repair of Spigelian hernia, causing acute small bowel obstruction in a 55-year-old man with liver disease and ascites that was diagnosed using a CT scan. We conducted a search of Medline, Embase, Science Citation Index, Current Contents, PubMed, and the Cochrane Database to review the history of laparoscopic repair of Spigelian hernia and its various advancements, which are briefly presented here.

Results:

The hernia was successfully reduced using laparoscopy, revealing a moderate-size defect in the linea semilunaris. The hernial defect was repaired with a composite mesh that was tacked into position. The patient was discharged from the hospital on the second postoperative day.

Conclusions:

Spigelian hernia in an emergency setting can be easily and swiftly repaired using the IPOM method utilizing a composite mesh.     

轻量型网片和普通聚丙烯补片在腹股沟疝修补术中的对比研究

目的探讨轻量型网片（强生UPP）在腹股沟疝无张力修补中的作用。方法回顾分析90例次腹股沟疝无张力修补患者的临床资料,其中47例次行普通聚丙烯材料修补,43例次行强生UPP修补。结果强生UPP修补组与普通聚丙烯材料修补组比较,早期并发症发生率（切口疼痛、切口积液、伤口感染、肺部感染、尿道损伤以及尿潴留等）和住院时间差异无统计学意义。在6个月时强生UPP修补组其局部切口疼痛、异物感的患者明显少于普通聚丙烯材料修补组,腹壁顺应性明显好于普通聚丙烯材料修补组,在6个月时两组均没有复发。结论轻量型网片在腹股沟疝无张力修补中,其后期并发症明显减少,有望成为腹股沟疝无张力修补的首选材料。     

Recurrent Spigelian hernia: a rare cause of colonic obstruction

Spigelian hernia is considered a surgical rarity. Recent articles describe only six recurrent hernias and a scant number of patients with colonic obstruction resulting from incarceration. A patient with intestinal obstruction resulting from recurrent Spigelian hernia with strangulated colon is described. The patient underwent tension-free repair using a prosthetic mesh. Recent literature suggests that the deficiency of connective tissue in patients with hernias justifies the widespread use of permanent mesh for tissue reinforcement and avoidance of recurrences. The rare case presented should be regarded as an illustrative example for application of the tension-free repair principle in the definitive management of recurrent Spigelian hernia. Electronic Publication     

腹股沟嵌顿疝充填式无张力修补术269例分析

目的探讨充填式无张力修补手术治疗腹股沟嵌顿疝的有效性和可行性。方法总结我院2003年1月至2008年1月对269例腹股沟嵌顿疝施行充填式无张力修补手术,观察手术后的局部疼痛、局部积液、切口感染以及术后复发情况,并加以分析。结果269例术后患者经2年以上随访,阴囊积液2例（0．7％）,短期复发2例（0．7％）,慢性疼痛15例（5．5％）,局部异物感53例（19．7％）。无手术死亡,无切口感染。结论充填式无张力修补手术治疗腹股沟嵌顿疝是有效、可行的。     

Spigelian hernia: an up-to-date

Nine cases of Spigelian hernia occurred and surgically treated in the years 1992-1997 are reported. Spigelian hernias were observed in 5 females and 3 males with mean age of 62.1 years (range 49-70). In 5 cases prosthetic repair has been done with preperitoneal mesh and a very good outcome. In a 61 years old obese female spigelian hernia was bilateral. Her left sided hernia needed an emergency operation for strangulation. Hernia has been repaired by simple suture and recurred early. For the diagnosis of Spigelian hernia it is essential to remember it inside the "Spigelian belt". The satisfactory results obtained at present by prosthetic repair are underlined.     

Spigelian hernia. A rare case of bilateral hernia and presentation of our experience

Spigelian hernia is a relatively rare defect of the abdominal wall. Due to its unspecific and variable clinical presentation, presents a difficult diagnostic challenge. We present a rare case of bilateral Spigelian hernia that was diagnosed and successfully treated with open surgery and hernioplasty. Also we present our experience in management of the disease. In our department the last fifteen years, 12 cases of Spigelian hernia have been treated surgically, using direct reconstruction with excellent results.     

Spigelian–cryptorchidism syndrome in an adult male complaining of primary infertility: Case report

History of cryptorchidism is present in about 10% of infertile patients seeking medical help, whereas 20% of them are azoospermic. Most of the patients with bilateral cryptorchidism have a low testicular volume and high serum FSH level. Ectopic testes are present only in 5% of the patients with cryptorchidism. The anterior abdominal wall is a rare site for ectopic testis where Spigelian hernia is usually accompanied. We present a case of bilateral ectopic anterior abdominal wall testes associated with Spigelian hernia on the left side.     

裁剪式双层prolene网片在老年腹股沟疝无张力修补术中的应用

目的 探讨裁剪式双层prolene网片在老年腹股沟疝无张力修补术中的临床应用价值。方法 对1997年7月至2005年7月应用裁剪式双层prolene网片行老年腹股沟疝无张力修补术56例的临床资料进行回顾性分析。结果 56例中，原发性腹股沟疝19例（33．9％），复发性腹股沟疝37例（66．1％）。巨大疝环12例（21．4％），伴发其他疾病44例（78．6％）。并发症发生率为10．7％（6／56）。平均手术时间45min；平均住院3．2d；随访6个月至8年，无术后复发。结论 应用裁剪式双层prolene网片进行腹股沟疝无张力修补术，符合老年腹股沟疝的解剖特点和“个体化”要求，尤其适合于老年巨大疝环者或复发性疝。由于操作简便、安全和经济等特点，易于广泛推广。     

Inguinal hernia masquerading as a Spigelian hernia in a child

Inguinal hernia is one of the most common conditions requiring surgical management in childhood. The usual presentation of congenital inguinal hernia in the pediatric age group is an inguino-scrotal swelling. We report a case of inguinal hernia in a child that presented as an abdominal wall swelling clinically suggestive of a Spigelian hernia.