Spigelian hernia: current approaches to surgical treatment-a review

Abstract

Background: Spigelian hernias (SpH) belong to the group of eponymous abdominal wall hernias. Major reasons for diagnostic difficulties are its low incidence reaching maximum 2% of abdominal wall hernias, a specific anatomical localization with intact external oblique aponeurosis covering the hernia sac and non-constant clinical presentation.

Methods: A literature review was completed to summarize current knowledge on surgical treatment options and results.

Results: SpH presents a high incarceration risk and therefore should be operated upon even if the patient is asymptomatic. Both laparoscopic and open repair approaches are validated by current guidelines with lesser postoperative complications and shorter hospital stay in favour of minimally invasive surgery, regardless of the technique used. Overall recurrence rate is very low.

Conclusion: All diagnosed SpH should be planned for elective operation to prevent strangulated hernia and, therefore emergency surgery. Both open and laparoscopic SpH treatment can be safely performed, depending on surgeon's experience. In most cases, a mesh repair is generally advised.

Keywords: Hernia surgery; Minimally invasive surgery; Review; Spigelian hernia; Surgical anatomy.

Fig. 1

Surgical anatomy of the abdominal wall. Abdominal wall anatomy, coronal view. (1)Transverse abdominal muscle, (2) Semilunar line, (3) Spigelian fascia, (4) Spigelian hernia belt, (5) Arcuate line, (6) inferior epigastric artery and vein, (7) Low Spigelian hernia area

Fig. 2

Spigelian Hernia surgical anatomy. Drawing depicting a left-sided Spigelian hernia, axial view. Note the Spigelian hernia penetrating the Spigelian fascia (red asterisks) with an intact External oblique aponeurosis. (1) Semilunar line, (2) Rectus abdominis muscle, (3) External oblique muscle with aponeurosis, (4) Internal oblique muscle, (5) Transverse abdominal muscle, (6) Fascia transversalis, (7) Pre-peritoneal fat, (8) Peritoneum

Fig. 3

Spigelian Hernia on CT scan. Abdominal CT-scan depicting left-sided incarcerated Spigelian Hernia with small bowel content (arrow). Note the intact External oblique aponeurosis (arrowheads)