Spigelian hernia

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

Contents

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.

Spigelian hernia
Other namesLateral ventral hernia
Spigelian Hernia.jpg
Transverse CT image of the abdomen in a patient with a Spigelian hernia (arrow).
Specialty General surgery

Spigelian hernias 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.

Photograph by AfroBrazilian, distributed under a CC BY-SA 3.0 license. Hernia spiegheli 01.JPG
Photograph by AfroBrazilian, distributed under a CC BY-SA 3.0 license.
Laparoscopic Hernia Surgery Laparoscopic stomach surgery.jpg
Laparoscopic Hernia Surgery

Signs and symptoms

Individuals typically present with either intermittent pain, a lump or mass, all which are classic signs of a bowel obstruction. [2] The patient may have a protuberance when standing in an upright position although discomfort can sometimes be confused by its anatomical region for a peptic ulceration. [3] The bulge may be painful when the patient stretches but then goes away when they are lying down in a resting position. [4] However, a number of patients present with no obvious symptoms but vague tenderness along the area in which the Spigelian fascia is located. [5]

Diagnosis

Ultrasound Imaging or a CT scan will provide better imaging for the detection of a hernia than an X-ray. [6] The ultrasound probe should move from lateral to medially, a hypoechoic mass should appear anteriorly and medially to the inferior epigastric artery during Valsalva maneuver. [7] The diagnosis of a Spigelian hernia is traditionally difficult if only given a history and physical examination. [8] People who are good candidates for elective Spigelian hernia surgery, 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. [9] Surgery is straightforward, with only larger defects requiring a mesh 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. [10] A Spigelian hernia becomes immediately operative once the risk of incarceration is confirmed.[ citation needed ] Today, a Spigelian hernia can be repaired by doing robotic laparoscopy and most patients are discharged on the same day. 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. [11] 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. [6] [12]

Eponym

Adriaan van den Spiegel was an anatomist at the University of Padua during the 17th century. He became a professor of surgery in 1619 and was the first to describe this rare hernia in 1627. [13] The history of the Spigelian hernia was acknowledged in 1645, twenty years after Spiegel's death. In 1764, almost a century later, the Flemish anatomist, Josef Klinkosch, was acknowledged for recognizing and describing a hernia located in the Spigelian fascia, and coined the term Spigelian hernia. [14]

Raveenthiran syndrome

Raveenthiran described a new syndrome in which Spigelian hernia and cryptorchidism (undescended testis) occur together. [15] Some common complications of this distinct syndrome cryptorchidism are testicular torsion, and its link to testicular cancer. [16]

Related Research Articles

The term abdominal surgery broadly covers surgical procedures that involve opening the abdomen (laparotomy). Surgery of each abdominal organ is dealt with separately in connection with the description of that organ Diseases affecting the abdominal cavity are dealt with generally under their own names.

<span class="mw-page-title-main">Laparoscopy</span> Minimally invasive operations within the abdominal or pelvic cavities

Laparoscopy is an operation performed in the abdomen or pelvis using small incisions with the aid of a camera. The laparoscope aids diagnosis or therapeutic interventions with a few small cuts in the abdomen.

<span class="mw-page-title-main">Hernia</span> Abnormal exit of tissues or organs from the cavity they usually reside in

A hernia is the abnormal exit of tissue or an organ, such as the bowel, through the wall of the cavity in which it normally resides. The term is also used for the normal development of the intestinal tract, referring to the retraction of the intestine from the extra-embryonal navel coelom into the abdomen in the healthy embryo at about 7½ weeks.

<span class="mw-page-title-main">Appendectomy</span> Surgical removal of the vermiform appendix

An appendectomy or appendicectomy is a surgical operation in which the vermiform appendix is removed. Appendectomy is normally performed as an urgent or emergency procedure to treat complicated acute appendicitis.

<span class="mw-page-title-main">Orchiopexy</span> Surgery to fix a testicle into the scrotum

Orchiopexy is a surgery to move and/or permanently fix a testicle into the scrotum. While orchiopexy typically describes the operation to surgically correct an undescended testicle, it is also used to resolve testicular torsion.

<span class="mw-page-title-main">Inguinal hernia</span> Medical condition in which contents of the abdominal cavity protrude through the inguinal canal

An inguinal hernia or groin hernia is a hernia (protrusion) of abdominal cavity contents through the inguinal canal. Symptoms, which may include pain or discomfort especially with or following coughing, exercise, or bowel movements, are absent in about a third of patients. Symptoms often get worse throughout the day and improve when lying down. A bulging area may occur that becomes larger when bearing down. Inguinal hernias occur more often on the right than left side. The main concern is strangulation, where the blood supply to part of the intestine is blocked. This usually produces severe pain and tenderness of the area.

<span class="mw-page-title-main">Hernia repair</span> Surgical procedures to fix abnormal openings through which tissue or organs may protrude

Hernia repair is a surgical operation for the correction of a hernia—a bulging of internal organs or tissues through the wall that contains it. It can be of two different types: herniorrhaphy; or hernioplasty. This operation may be performed to correct hernias of the abdomen, groin, diaphragm, brain, or at the site of a previous operation. Hernia repair is often performed as an ambulatory procedure.

<span class="mw-page-title-main">Robot-assisted surgery</span> Surgical procedure

Robot-assisted surgery or robotic surgery are any types of surgical procedures that are performed using robotic systems. Robotically assisted surgery was developed to try to overcome the limitations of pre-existing minimally-invasive surgical procedures and to enhance the capabilities of surgeons performing open surgery.

<span class="mw-page-title-main">Umbilical hernia</span> Medical condition

An umbilical hernia is a health condition where the abdominal wall behind the navel is damaged. It may cause the navel to bulge outwards—

Femoral hernias occur just below the inguinal ligament, when abdominal contents pass through a naturally occurring weakness in the abdominal wall called the femoral canal. Femoral hernias are a relatively uncommon type, accounting for only 3% of all hernias. While femoral hernias can occur in both males and females, almost all develop in women due to the increased width of the female pelvis. Femoral hernias are more common in adults than in children. Those that do occur in children are more likely to be associated with a connective tissue disorder or with conditions that increase intra-abdominal pressure. Seventy percent of pediatric cases of femoral hernias occur in infants under the age of one.

An incisional hernia is a type of hernia caused by an incompletely-healed surgical wound. Since median incisions in the abdomen are frequent for abdominal exploratory surgery, ventral incisional hernias are often also classified as ventral hernias due to their location. Not all ventral hernias are from incisions, as some may be caused by other trauma or congenital problems.

<span class="mw-page-title-main">Bowel resection</span> Surgical procedure in which a part of an intestine is removed

A bowel resection or enterectomy is a surgical procedure in which a part of an intestine (bowel) is removed, from either the small intestine or large intestine. Often the word enterectomy is reserved for the sense of small bowel resection, in distinction from colectomy, which covers the sense of large bowel resection. Bowel resection may be performed to treat gastrointestinal cancer, bowel ischemia, necrosis, or obstruction due to scar tissue, volvulus, and hernias. Some patients require ileostomy or colostomy after this procedure as alternative means of excretion. Complications of the procedure may include anastomotic leak or dehiscence, hernias, or adhesions causing partial or complete bowel obstruction. Depending on which part and how much of the intestines are removed, there may be digestive and metabolic challenges afterward, such as short bowel syndrome.

Post herniorrhaphy pain syndrome, or inguinodynia is pain or discomfort lasting greater than 3 months after surgery of inguinal hernia. Randomized trials of laparoscopic vs open inguinal hernia repair have demonstrated similar recurrence rates with the use of mesh and have identified that chronic groin pain (>10%) surpasses recurrence (<2%) and is an important measure of success.

<span class="mw-page-title-main">Adriaan van den Spiegel</span> Flemish anatomist

Adriaan van den Spiegel, name sometimes written as Adrianus Spigelius, was a Flemish anatomist born in Brussels. For much of his career he practiced medicine in Padua, and is considered one of the great physicians associated with the city. At Padua he studied anatomy under Girolamo Fabrici.

<span class="mw-page-title-main">Diastasis recti</span> Medical condition

Diastasis recti, or rectus abdominis diastasis, is defined as a gap of about 2.7 cm or greater between the two sides of the rectus abdominis muscle. The distance between the right and left rectus abdominis muscles is created by the stretching of the linea alba, a connective collagen sheath created by the aponeurosis insertions of the transverse abdominis, internal oblique, and external oblique. This condition has no associated morbidity or mortality. Physical therapy is often required to repair this separation and surgery is an option for more severe cases. Standard exercise rarely results in complete healing of the separated muscles.

<span class="mw-page-title-main">Obturator hernia</span> Medical condition

An obturator hernia is a rare type of hernia, encompassing 0.07-1% of all hernias, of the pelvic floor in which pelvic or abdominal contents protrudes through the obturator foramen. The obturator foramen is formed by a branch of the ischial as well as the pubic bone. The canal is typically 2-3 centimeters long and 1 centimeters wide, creating a space for pouches of pre-peritoneal fat.

De Garengeot's hernia is a rare subtype of an incarcerated femoral hernia. This eponym may be used to describe the incarceration of the vermiform appendix within a femoral hernia. This mechanism is contrasted with the Amyand hernia, in which the appendix protrudes through an inguinal hernia.

The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) is a 501c6 non-profit professional organization providing education on gastrointestinal minimally invasive surgery. It describes itself thus: The mission of the Society of American Gastrointestinal and Endoscopic Surgeons is to innovate, educate and collaborate to improve patient care.

<span class="mw-page-title-main">Inguinal hernia surgery</span> Medical procedure

Inguinal hernia surgery is an operation to repair a weakness in the abdominal wall that abnormally allows abdominal contents to slip into a narrow tube called the inguinal canal in the groin region.

<span class="mw-page-title-main">Surgical mesh</span> Material used in surgery

Surgical mesh is a medical implant made of loosely woven mesh, which is used in surgery as either a permanent or temporary structural support for organs and other tissues. Surgical mesh can be made from both inorganic and biological materials and is used in a variety of surgeries, although hernia repair is the most common application. It can also be used for reconstructive work, such as in pelvic organ prolapse or to repair physical defects created by extensive resections or traumatic tissue loss.

References

  1. Skandalakis, PN; Zoras, O (2006-12-01). "Spigelian hernia: surgical anatomy, embryology, and technique of repair". The American Surgeon. 72 (1): 42–8. doi: 10.1177/000313480607200110 . PMID   16494181. S2CID   26111951.
  2. Larson, David W.; Farley, David R. (2002-10-01). "Spigelian Hernias: Repair and Outcome for 81 Patients". World Journal of Surgery. 26 (10): 1277–1281. doi:10.1007/s00268-002-6605-0. ISSN   1432-2323. PMID   12205553. S2CID   24674266.
  3. Mittal, T; Kumar, V; Sharma, R; Soni, V; Baijal, M; Chowbey, P.K. (2008). "Diagnosis and management of Spigelian Hernia: A review of literature and our experience". Journal of Minimal Access Surgery. 4 (4): 95–98. doi: 10.4103/0972-9941.45204 . PMC   2699222 . PMID   19547696.
  4. Zucker, Benjamin; Malietzis, George; Kontovounisios, Christos (2017-10-01). "An Unexpected Cause of Acute Abdomen". Gastroenterology. 153 (4): e4–e5. doi: 10.1053/j.gastro.2017.01.057 . ISSN   0016-5085. PMID   28881194.
  5. Light, D; Chattopadhyay, D; Bawa, S (2013). "Radiological and clinical examination in the diagnosis of Spigelian hernias". Annals of the Royal College of Surgeons of England. 95 (2): 98–100. doi:10.1308/003588413X13511609957092. ISSN   0035-8843. PMC   4098597 . PMID   23484989.
  6. 1 2 Bittner JG, Edwards MA, Shah MB, MacFadyen BV, Mellinger JD (August 2008). "Mesh-free laparoscopic spigelian hernia repair". The American Surgeon. 74 (8): 713–20, discussion 720. doi: 10.1177/000313480807400808 . PMID   18705572. S2CID   31085191.
  7. Jamadar DA, Jacobson JA, Morag Y, Girish G, Ebrahim F, Gest T, Franz M (July 2006). "Sonography of inguinal region hernias". AJR. American Journal of Roentgenology. 187 (1): 185–90. doi:10.2214/AJR.05.1813. PMID   16794175.
  8. Tom, SK; Tom, TN (2019). "Laparoscopic Repair of Right Spigelian Hernia and Umbilical Hernia. - PubMed - NCBI". The American Surgeon. 85 (5): e268–e270. doi: 10.1177/000313481908500514 . ISSN   1555-9823. PMID   31126386. S2CID   174813338.
  9. 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. S2CID   37633720.
  10. Köckerling, Ferdinand; Lammers, Bernhard (2018-10-23). "Open Intraperitoneal Onlay Mesh (IPOM) Technique for Incisional Hernia Repair". Frontiers in Surgery. 5: 66. doi: 10.3389/fsurg.2018.00066 . ISSN   2296-875X. PMC   6206818 . PMID   30406110.
  11. Bittner, James G. IV (2010-10-02). "Mesh-free Laparoscopic Repair of Small Spigelian Hernias". Surgical Laparoscopy Endoscopy & Percutaneous Techniques. 20 (1): 63–64. doi:10.1097/SLE.0b013e3181cb842c. ISSN   1530-4515. PMID   20173625.
  12. Understanding Strangulated Hernias
  13. Ghosh, Sanjib Kumar; Sharma, Suranjali; Biswas, Sudipa; Chakraborty, Soumya (2014). "Adriaan van den Spiegel (1578–1625): Anatomist, physician, and botanist". Clinical Anatomy. 27 (7): 952–957. doi:10.1002/ca.22414. ISSN   1098-2353. PMID   24811238. S2CID   12342472.
  14. Uchiyama, Kiichiro (1998). "Reports on Experiments Kilchiro and Clinical Cases". Spigelian Hernia: Case Study.
  15. Raveenthiran V (Dec 2005). "Congenital Spigelian hernia with cryptorchidism: probably a new syndrome". Hernia. 9 (4): 378–80. doi:10.1007/s10029-005-0316-z. PMID   15782280. S2CID   28058188.
  16. Kariappa, Mohan Kumar; Vivek, Harihar (2016). "Pantaloon Hernia: Obstructed indirect Component and Direct Component with Cryptorchidism". Case Reports in Surgery. 2011: 1461425. doi: 10.1155/2016/1461425 . PMC   4989057 . PMID   27579208.