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Kavya SS, Shaikh FA, Shaikh H, Mushahid H, Sydhom M, Nadeem A. Giant spigelian hernia in a middle-aged female: The importance of intraoperative ultrasonography for hernia localization-Case report. SAGE Open Med Case Rep 2024; 12:2050313X241249099. [PMID: 38665933 PMCID: PMC11044791 DOI: 10.1177/2050313x241249099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 04/04/2024] [Indexed: 04/28/2024] Open
Abstract
Spigelian hernia is a rare type of abdominal wall hernia that accounts for only 0.12% of all abdominal hernias. A Spigelian hernia, also known as a spontaneous lateral ventral hernia or a hernia of the semilunar line, occurs when a part of the abdominal contents protrudes through the Spigelian fascia. Due to its anatomical location, Spigelian hernia can be difficult to diagnose through physical examination alone. Here we report a case of a 40-year-old female who experienced right abdominal pain and swelling, where ultrasonography imaging was crucial in the intraoperative diagnosis of Spigelian hernia. The patient underwent laparotomy mesh repair to address the condition. The lack of consistent physical findings and the rarity of the disease require a high level of clinical suspicion in the diagnosis of a Spigelian hernia. Its associated abdominal complaints are often vague and nonspecific, making it even more challenging. This case emphasizes the importance of utilizing imaging techniques to aid in the diagnosis of a Spigelian hernia and prompt surgical intervention to prevent complications associated with the hernia.
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Affiliation(s)
- Sanka Sai Kavya
- Department of General Surgery, SVS Medical College, Yenugonda, India
| | | | - Humaira Shaikh
- Shadan Institute of Medical Sciences and Research, Peeramchuru, Telangana, India
| | - Hasan Mushahid
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Mark Sydhom
- Department of Medicine, Ain Shams University, Cairo, Egypt
| | - Abdullah Nadeem
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
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2
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Lowrie NR, Richter KK, Orizu MN. Diagnosis and treatment of a rare case of an incarcerated bilateral Spigelian hernia with the vermiform appendix and caecum. BMJ Case Rep 2023; 16:e251931. [PMID: 37553169 PMCID: PMC10414057 DOI: 10.1136/bcr-2022-251931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023] Open
Abstract
Spigelian hernia is a rare form of abdominal wall defect. Bilateral Spigelian hernias are even less common. Surgical repair of Spigelian hernias is recommended due to their high risk of incarceration and strangulation of abdominal contents. A variety of surgical approaches to repair these hernias have been described in the literature including the traditional open approach, laparoscopic transabdominal preperitoneal approach, laparoscopic intraperitoneal repair and laparoscopic totally extraperitoneal repair. Here, we present the case of an elderly female patient with rare bilateral Spigelian hernias, the right side containing incarcerated appendix and caecal pole. The left hernia was unrecognised on preoperative CT imaging. To our knowledge, very few cases have been reported in the literature. The patient underwent bilateral laparoscopic intraperitoneal mesh repair. All technical aspects of the treatment are discussed here, in the context of the current literature, including the surgical technique and the limitations of the CT diagnosis. We aim to summarise the background of these uncommon hernias, the limitations of preoperative investigations and the differences between the available operative approaches.
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Affiliation(s)
- Neil Robert Lowrie
- General Surgery, University of Otago School of Medicine, Dunedin, New Zealand
- General Surgery, Southland Hospital, Invercargill, New Zealand
| | - Konrad Klaus Richter
- General Surgery, Southland Hospital, Invercargill, New Zealand
- Dean's Department, University of Otago School of Medicine, Dunedin, New Zealand
| | - Mavis N Orizu
- General Surgery, Southland Hospital, Invercargill, New Zealand
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3
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Garcia EM, Pietryga JA, Kim DH, Fowler KJ, Chang KJ, Kambadakone AR, Korngold EK, Liu PS, Marin D, Moreno CC, Panait L, Santillan CS, Weinstein S, Wright CL, Zreloff J, Carucci LR. ACR Appropriateness Criteria® Hernia. J Am Coll Radiol 2022; 19:S329-S340. [PMID: 36436960 DOI: 10.1016/j.jacr.2022.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 09/07/2022] [Indexed: 11/27/2022]
Abstract
Abdominopelvic hernias are common clinical entities composed of a wide variety of congenital, traumatic, and iatrogenic etiologies. Any weakness in the body wall may result in hernia of cavity contents with concomitant risks of morbidity and mortality. Presentations may be specific, palpable body wall mass/bulge, or vague, nonspecific pain through bowel obstruction. This document focuses on initial imaging of the adult population with signs of symptoms prompting suspicion of abdominopelvic hernia. Imaging of the abdomen and pelvis to evaluate defects is essential for prompt diagnosis and treatment. Often CT and ultrasound are the first-line modalities to quickly evaluate the abdomen and pelvis, providing for accurate diagnoses and management of patients. MRI protocols may be useful as first-line imaging studies, especially in patients with orthopedic instrumentation. Although often performed, abdominal radiographs and fluorographic procedures may provide indirect evidence of hernias but are usually not indicated for initial diagnosis of hernia. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer-reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer-reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Evelyn M Garcia
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia; Board Member, Taubman Museum of Art.
| | - Jason A Pietryga
- Division Chief, Emergency Radiology at UNC Chapel Hill, Chapel Hill North Carolina; and University of Alabama at Birmingham, Birmingham, Alabama
| | - David H Kim
- Panel Chair, University of Wisconsin Hospital & Clinics, Madison, Wisconsin; and Vice-Chair of Education, University of Wisconsin Department of Radiology
| | - Kathryn J Fowler
- Panel Vice-Chair, University of California San Diego, San Diego, California; Chair ACR LI-RADS; Division Chief, SAR Portfolio Director, RSNA Radiology Senior Deputy Editor
| | - Kevin J Chang
- Boston University Medical Center, Boston, Massachusetts; Section Chief of Abdominal Imaging, Director of MRI, Chair of Committee on C-RADS
| | - Avinash R Kambadakone
- Massachusetts General Hospital, Boston, Massachusetts; Division Chief, Abdominal Imaging, Massachusetts General Hospital and Medical Director, Martha's Vineyard Hospital Imaging
| | - Elena K Korngold
- Section Chief, Body Imaging/Chair, Department of Radiology Promotion and Tenure Committee; Oregon Health and Science University, Portland, Oregon
| | - Peter S Liu
- Section Head, Abdominal Imaging, Cleveland Clinic, Cleveland, Ohio
| | - Daniele Marin
- Duke University Medical Center, Durham, North Carolina
| | | | - Lucian Panait
- President, Minnesota Hernia Center, Minneapolis, Minnesota; American College of Surgeons; American Hernia Society (member of the Technology and Value Assessment Committee); Practice Advisory Committee Member, American Hernia Society
| | - Cynthia S Santillan
- Vice-Chair of Clinical Operations, Department of Radiology, University of California San Diego, San Diego, California
| | | | | | - Jennifer Zreloff
- Georgia, Primary Care Physician, Emory University, Atlanta, Georiga; Medical Director, Seavey General Medicine Clinic; Assistant Director of Innovation Seavey Comprehensive Internal Medicine Clinic, Emory University, Atlanta, Georgia
| | - Laura R Carucci
- Specialty Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia; Section Chief Abdominal Imaging, Director of MRI and CT
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4
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Stanley GHM, Gilliland T, Trinder MW, Wong E, Liew YX, Ryan J. Laparoscopic repair of a Spigelian hernia with appendicitis in situ. ANZ J Surg 2022; 92:2701-2703. [PMID: 35866486 PMCID: PMC9796439 DOI: 10.1111/ans.17930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 07/14/2022] [Indexed: 01/01/2023]
Affiliation(s)
- Guy H. M. Stanley
- Department of surgeryFiona Stanley HospitalMurdochWestern AustraliaAustralia,Department of Surgery, Medical schoolUniversity of Western AustraliaCrawleyWestern AustraliaAustralia
| | - Tristan Gilliland
- Department of surgeryFiona Stanley HospitalMurdochWestern AustraliaAustralia
| | - Matthew W. Trinder
- Department of surgeryFiona Stanley HospitalMurdochWestern AustraliaAustralia
| | - Enoch Wong
- Department of surgeryFiona Stanley HospitalMurdochWestern AustraliaAustralia
| | - Yu Xin Liew
- Department of surgeryFiona Stanley HospitalMurdochWestern AustraliaAustralia
| | - Jennifer Ryan
- Department of surgeryFiona Stanley HospitalMurdochWestern AustraliaAustralia
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5
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How Often Occult Inguinal or Spigelian Hernias Detected During Laparoscopy of Other Reasons Are Later Operated? SURGICAL LAPAROSCOPY, ENDOSCOPY & PERCUTANEOUS TECHNIQUES 2022; 32:519-522. [PMID: 36130721 DOI: 10.1097/sle.0000000000001095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/23/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The incidence of occult inguinal or Spigelian hernias found in other laparoscopies is seldom studied and their development to symptomatic hernias is unknown. MATERIALS AND METHODS The orifices of all inguinal and Spigelian hernias at linea semilunaris were carefully recorded prospectively in the laparoscopic surgery during the years 2003-2004 (104 cholecystectomies, 55 fundoplications, 36 diagnostic, and 6 miscellaneous). The patients were followed up over 15 years to find out how often the detected occult hernias at index laparoscopy become later symptomatic and were repaired. RESULTS The index laparoscopic operation was performed to 201 patients with a mean age of 53±14 years. The overall frequency of unexpected hernias was 21% including 36 (18%) inguinal hernias, 5 (2.5%) Spigelian hernias, and 2 (1.0%) ventral hernias. At the index laparoscopy, only 5/201 inguinal and 2 Spigelian hernioplasties were concomitantly undertaken. After 15 years, data of 169 patients were available and new hernia repairs were performed only in 8 (4.7%) patients (2 inguinal, 4 umbilical, and 2 ventral hernias). CONCLUSIONS Asymptomatic occult hernias detected during laparoscopic surgery of other reason evolve very seldom (<5%) to symptomatic and need to be repaired.
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Hanzalova I, Schäfer M, Demartines N, Clerc D. Spigelian hernia: current approaches to surgical treatment-a review. Hernia 2021; 26:1427-1433. [PMID: 34665343 DOI: 10.1007/s10029-021-02511-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 09/05/2021] [Indexed: 12/15/2022]
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.
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Affiliation(s)
- I Hanzalova
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Bugnon 46, 1011, Lausanne, Switzerland
| | - M Schäfer
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Bugnon 46, 1011, Lausanne, Switzerland.
| | - N Demartines
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Bugnon 46, 1011, Lausanne, Switzerland
| | - D Clerc
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Bugnon 46, 1011, Lausanne, Switzerland
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Cui TYS, Law TT, Ng L, Wong KY. Spigelian hernia: Our total extraperitoneal approach and a systematic review of the literature. Asian J Endosc Surg 2021; 14:529-539. [PMID: 33393194 DOI: 10.1111/ases.12912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 12/07/2020] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Spigelian hernia is a rare lateral ventral hernia traditionally repaired through open incision with extensive dissection. Three laparoscopic techniques have been reported in the literature: intraperitoneal onlay mesh (IPOM), transabdominal preperitoneal (TAPP), and total extraperitoneal (TEP). TEP is less popular than the other approaches. We evaluated TEP's safety and effectiveness and compared different laparoscopic techniques. METHODS All patients with Spigelian hernia who had undergone extended TEP (eTEP) repair with mesh in our center from January 2007 to February 2020 were studied. A three-port technique with a preperitoneal space created by telescope at the midline was adopted. A systematic review on laparoscopic mesh repair was performed by searching for "Spigelian hernia" and "laparoscopic" from 1999 to 2019 in the MEDLINE database. RESULTS Seven patients underwent eTEP repair for Spigelian hernia. Five presented with abdominal mass and underwent preoperative imaging. Two were diagnosed incidentally during TEP for inguinal hernia. The mean operative duration was 65 minutes (range, 40-93 minutes). There were no open conversions or intraoperative complications. The mean length of hospital stay was 1.4 days (range, 1-3 days). The mean follow-up period was 44.3 months. One patient developed seroma. There was no recurrence or chronic pain. We identified 197 laparoscopic mesh repairs reported in 41 articles. IPOM (n = 91) was the most popular approach, followed by TAPP (n = 70) and TEP (n = 36). Laparoscopic mesh repair of Spigelian hernia is safe and offers excellent outcomes. CONCLUSION We found the eTEP approach safe and effective for Spigelian hernia repair. IPOM, TAPP, and TEP are comparable.
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Affiliation(s)
| | - Tsz Ting Law
- Department of Surgery, Tung Wah Hospital, Hong Kong
| | - Lily Ng
- Department of Surgery, Tung Wah Hospital, Hong Kong
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Cesaro E, Rocco C, Rosano N, Ferrandino G, Marra E, Rispoli C, Maio D, Lugarà M, Tamburrini S, Marano I. "Bulb-like" sign: Small bowel closed loop obstruction in incarcerated Spigelian hernia. Radiol Case Rep 2021; 16:520-523. [PMID: 33376569 PMCID: PMC7758278 DOI: 10.1016/j.radcr.2020.12.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 12/12/2020] [Accepted: 12/12/2020] [Indexed: 12/12/2022] Open
Abstract
A Spigelian hernia is a rare hernia, making up approximately 0.1% of all abdominal wall hernias. This hernia goes through a defect in the Spigelian fascia which is the part of the transversus abdominis aponeurosis lateral to the rectus muscle, often at the level of the arcuate line, where the fascia is widest and weakest. Clinical diagnosis is difficult in patients without obvious abdominal mass but imaging can be a valuable adjunct in diagnosis. We report the case of a 64-year-old male who presented to our hospital with small bowel obstruction secondary to an incarcerated Spigelian hernia who was pre-operatively diagnosed with ultrasound and computed tomography. At ultrasound and computed tomography a closed loop obstruction in a Spigelian Hernia was detected, resembling on both imaging modalities a "bulb-like" appearance.
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Affiliation(s)
- Edoardo Cesaro
- Department of Radiology, "Università degli Studi della Campania Luigi Vanvitelli", Naples, Italy
| | - Concetta Rocco
- Department of Radiology, Ospedale del Mare, ASL NA1 Centro, Via Enrico Russo, 80147, Naples, Italy
| | - Nicola Rosano
- Department of Radiology, Ospedale del Mare, ASL NA1 Centro, Via Enrico Russo, 80147, Naples, Italy
| | - Giovanni Ferrandino
- Department of Radiology, Ospedale del Mare, ASL NA1 Centro, Via Enrico Russo, 80147, Naples, Italy
| | - Ester Marra
- Department of Surgery, University of Naples "Federico II", Naples, Italy
| | - Corrado Rispoli
- Department of Surgery, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Domenico Maio
- Department of Anesthesia and Critical Care, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Marina Lugarà
- Department of Internal Medicine, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Stefania Tamburrini
- Department of Radiology, Ospedale del Mare, ASL NA1 Centro, Via Enrico Russo, 80147, Naples, Italy
| | - Ines Marano
- Department of Radiology, Ospedale del Mare, ASL NA1 Centro, Via Enrico Russo, 80147, Naples, Italy
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9
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Chand JT, Ramachandran R, Nair CG. A Jack or Two in the Box in a Case of Recurrent Inguinal Hernia. Indian J Surg 2020. [DOI: 10.1007/s12262-019-01948-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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10
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Henriksen NA, Montgomery A, Kaufmann R, Berrevoet F, East B, Fischer J, Hope W, Klassen D, Lorenz R, Renard Y, Garcia Urena MA, Simons MP. Guidelines for treatment of umbilical and epigastric hernias from the European Hernia Society and Americas Hernia Society. Br J Surg 2020; 107:171-190. [PMID: 31916607 DOI: 10.1002/bjs.11489] [Citation(s) in RCA: 136] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/31/2019] [Accepted: 12/02/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Umbilical and epigastric hernia repairs are frequently performed surgical procedures with an expected low complication rate. Nevertheless, the optimal method of repair with best short- and long-term outcomes remains debatable. The aim was to develop guidelines for the treatment of umbilical and epigastric hernias. METHODS The guideline group consisted of surgeons from Europe and North America including members from the European Hernia Society and the Americas Hernia Society. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach, the Scottish Intercollegiate Guidelines Network (SIGN) critical appraisal checklists, and the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument were used. A systematic literature search was done on 1 May 2018, and updated on 1 February 2019. RESULTS Literature reporting specifically on umbilical and epigastric hernias was limited in quantity and quality, resulting in a majority of the recommendations being graded as weak, based on low-quality evidence. The main recommendation was to use mesh for repair of umbilical and epigastric hernias to reduce the recurrence rate. Most umbilical and epigastric hernias may be repaired by an open approach with a preperitoneal flat mesh. A laparoscopic approach may be considered if the hernia defect is large, or if the patient has an increased risk of wound morbidity. CONCLUSION This is the first European and American guideline on the treatment of umbilical and epigastric hernias. It is recommended that symptomatic umbilical and epigastric hernias are repaired by an open approach with a preperitoneal flat mesh.
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Affiliation(s)
- N A Henriksen
- Department of Surgery, Zealand University Hospital, Koege, Denmark
| | - A Montgomery
- Department of Surgery, Lund University, Skåne University Hospital, Malmö, Sweden
| | - R Kaufmann
- Erasmus University Medical Centre, Rotterdam, the Netherlands.,Tergooi, Hilversum, the Netherlands
| | - F Berrevoet
- Department of General and Hepatopancreatobiliary Surgery, Ghent University Hospital, Ghent, Belgium
| | - B East
- Third Department of Surgery at Motol University Hospital, First and Second Faculty of Medicine at Charles University, Prague, Czech Republic
| | - J Fischer
- University of Pennsylvania Health System, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania, USA
| | - W Hope
- New Hanover Regional Medical Center, Wilmington, North Carolina, USA
| | - D Klassen
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - R Lorenz
- Praxis 3+ Chirurgen, Berlin, Germany
| | - Y Renard
- Department of Digestive Surgery, Robert Debré University Hospital, Reims, France
| | - M A Garcia Urena
- Henares University Hospital, Faculty of Health Sciences, Francisco de Vitoria University, Madrid, Spain
| | - M P Simons
- Department of Surgery, OLVG Hospital, Amsterdam, the Netherlands
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11
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Henriksen NA, Kaufmann R, Simons MP, Berrevoet F, East B, Fischer J, Hope W, Klassen D, Lorenz R, Renard Y, Garcia Urena MA, Montgomery A. EHS and AHS guidelines for treatment of primary ventral hernias in rare locations or special circumstances. BJS Open 2020; 4:342-353. [PMID: 32207571 PMCID: PMC7093793 DOI: 10.1002/bjs5.50252] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 11/26/2019] [Indexed: 01/11/2023] Open
Abstract
Background Rare locations of hernias, as well as primary ventral hernias under certain circumstances (cirrhosis, dialysis, rectus diastasis, subsequent pregnancy), might be technically challenging. The aim was to identify situations where the treatment strategy might deviate from routine management. Methods The guideline group consisted of surgeons from the European and Americas Hernia Societies. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used in formulating the recommendations. The Scottish Intercollegiate Guidelines Network (SIGN) critical appraisal checklists were used to evaluate the quality of full‐text papers. A systematic literature search was performed on 1 May 2018 and updated 1 February 2019. The Appraisal of Guidelines for Research and Evaluation (AGREE) instrument was followed. Results Literature was limited in quantity and quality. A majority of the recommendations were graded as weak, based on low quality of evidence. In patients with cirrhosis or on dialysis, a preperitoneal mesh repair is suggested. Subsequent pregnancy is a risk factor for recurrence. Repair should be postponed until after the last pregnancy. For patients with a concomitant rectus diastasis or those with a Spigelian or lumbar hernia, no recommendation could be made for treatment strategy owing to lack of evidence. Conclusion This is the first European and American guideline on the treatment of umbilical and epigastric hernias in patients with special conditions, including Spigelian and lumbar hernias. All recommendations were weak owing to a lack of evidence. Further studies are needed on patients with rectus diastasis, Spigelian and lumbar hernias.
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Affiliation(s)
- N A Henriksen
- Department of Surgery, Zealand University Hospital, Koege, Denmark
| | - R Kaufmann
- Erasmus University Medical Centre, Rotterdam, the Netherlands.,Tergooi, Hilversum, the Netherlands
| | - M P Simons
- Department of Surgery, OLVG Hospital, Amsterdam, the Netherlands
| | - F Berrevoet
- Department of General and Hepato-Pancreato-Biliary Surgery, Gent University Hospital, Gent, Belgium
| | - B East
- Third Department of Surgery, Motol University Hospital, Prague, Czech Republic.,First and Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - J Fischer
- University of Pennsylvania Health System, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania, USA
| | - W Hope
- New Hanover Regional Medical Center, Wilmington, North Carolina, USA
| | - D Klassen
- Department of Surgery, Dalhousie University, Halifax, Canada
| | - R Lorenz
- Praxis 3+CHIRURGEN, Berlin, Germany
| | - Y Renard
- Department of Digestive Surgery, Robert Debré University Hospital, Reims, France
| | - M A Garcia Urena
- Henares University Hospital, Faculty of Health Sciences, Francisco de Vitoria University, Madrid, Spain
| | - A Montgomery
- Department of Surgery, Lund University, Skåne University Hospital, Malmö, Sweden
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12
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Di Furia M, Romano L, Salvatorelli A, Brandolin D, Lazzarin G, Schietroma M, Carlei F, Giuliani A. Giant Spigelian Hernia presenting as small bowel obstruction: Case report and review of literature. Int J Surg Case Rep 2019; 63:118-121. [PMID: 31585321 PMCID: PMC6796652 DOI: 10.1016/j.ijscr.2019.09.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 07/26/2019] [Accepted: 09/16/2019] [Indexed: 11/28/2022] Open
Abstract
Spigelian Hernia is a rare abdominal wall hernia. Urgent presentation with small bowel obstruction is uncommon. Laparoscopy could be an option in elective surgery but in emergent setting laparotomy is required. Mesh repair is mandatory to avoid recurrence.
Introduction Spigelian Hernia is an uncommon pathology of abdominal wall (0.12–2.4%), usually small sized and with vague symptoms. It rarely presents as Small Bowel Obstruction or reaches dimensions that becomes clinically remarkable. Presentation of case 84-year-old woman entered our Surgical Department for Small Bowel Obstruction due to a giant (8 × 7 cm) abdominal wall hernia, which was intraoperatively identified as Spigelian Hernia. We performed a minilaparotomy with reduction of viable small bowel and preperitoneal positioning of polypropilene mesh. Postoperative course was uneventfull. Discussion Due to its small dimensions and infrequence, the diagnosis could be challenging even if the patient undergoes a CT scan. The presentation with clear signs of small bowel obstruction associated with a large abdominal hernia is rare and suggests a urgent surgical approach with mesh repair to avoid recurrences. Conclusion Even if rarely symptomatic, the Spigelian Hernia is an entity to consider in the differential diagnosis of small bowel obstruction in a virgin abdomen. Preoperative diagnosis, when available, is mandatory to guide a correct surgical approach.
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Affiliation(s)
- Marino Di Furia
- Department of General Surgery, Hospital San Salvatore L'Aquila, University of L'Aquila, Italy.
| | - Lucia Romano
- Department of General Surgery, Hospital San Salvatore L'Aquila, University of L'Aquila, Italy
| | - Andrea Salvatorelli
- Department of General Surgery, Hospital San Salvatore L'Aquila, University of L'Aquila, Italy
| | - Denise Brandolin
- Department of General Surgery, Hospital San Salvatore L'Aquila, University of L'Aquila, Italy
| | - Gianni Lazzarin
- Department of General Surgery, Hospital San Salvatore L'Aquila, University of L'Aquila, Italy
| | - Mario Schietroma
- Department of General Surgery, Hospital San Salvatore L'Aquila, University of L'Aquila, Italy
| | - Francesco Carlei
- Department of General Surgery, Hospital San Salvatore L'Aquila, University of L'Aquila, Italy
| | - Antonio Giuliani
- Department of General Surgery, Hospital San Salvatore L'Aquila, University of L'Aquila, Italy
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13
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Kwok AMF, Sarofim M, Still AB. Terminal ileum within a Spigelian hernia: a rare presentation of small bowel obstruction. ANZ J Surg 2019; 89:E564-E565. [PMID: 30690818 DOI: 10.1111/ans.14976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 10/24/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Allan M F Kwok
- Department of Surgery, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Mina Sarofim
- Department of Surgery, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Andrew B Still
- Department of Surgery, Wollongong Hospital, Wollongong, New South Wales, Australia
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Fernández-Moreno MC, Martí-Cuñat E, Pou G, Ortega J. Intraperitoneal Onlay Mesh Technique for Spigelian Hernia in an Outpatient and Short-Stay Surgery Unit: What’s New in Intraperitoneal Meshes? J Laparoendosc Adv Surg Tech A 2018; 28:700-704. [DOI: 10.1089/lap.2017.0319] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
| | | | - Guillermo Pou
- Department of Surgery, Clinic University Hospital, Valencia, Spain
| | - Joaquín Ortega
- Department of Surgery, Clinic University Hospital, Valencia, Spain
- Department of Surgery, University of Valencia, Valencia, Spain
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Xu L, Dulku G, Ho R. A rare presentation of Spigelian hernia involving the appendix. Eur J Radiol Open 2017; 4:141-143. [PMID: 29159208 PMCID: PMC5683672 DOI: 10.1016/j.ejro.2017.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 11/01/2017] [Accepted: 11/01/2017] [Indexed: 11/29/2022] Open
Abstract
Spigelian hernia (SH) is a rare entity accounting for 1–2% of ventral abdominal wall hernias. Elusive clinical signs and symptoms pose a diagnostic challenge and a consequent risk of strangulation. We present an emergent case of a Spigelian hernia involving the appendix.
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Affiliation(s)
- Ling Xu
- Department of Diagnostic and Interventional Radiology, Royal Perth Hospital, Perth, WA, Australia
| | - Gurjeet Dulku
- Department of Diagnostic and Interventional Radiology, Royal Perth Hospital, Perth, WA, Australia
| | - Richard Ho
- Department of Diagnostic and Interventional Radiology, Royal Perth Hospital, Perth, WA, Australia
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Abstract
Pediatric emergency medicine physicians may be able to use point-of-care ultrasound (POCUS) as a tool to evaluate abdominal wall masses. We present a case of a 2-month-old infant with a lower abdominal mass identified as a hernia sac by POCUS. It was initially thought to represent a Spigelian-type abdominal wall hernia but subsequently determined to be an unusual presentation of an inguinal hernia with testicular entrapment. We review each of these diagnoses in addition to relevant POCUS findings.
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Veréb-Amolini L, Betschart T, Kiss E, Ullrich O, Wildi S, Eppler E. An atypical lateral hernia and concomitant inguinal and umbilical hernias in a patient with polycystic kidney disease and an intracranial aneurysm - a combined approach of clinical and radiological investigation, endoscopic hernia repair, and anatomical cadaver model documentation and a systematic review of the literature. SPRINGERPLUS 2015; 4:85. [PMID: 25763300 PMCID: PMC4351262 DOI: 10.1186/s40064-015-0857-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 01/27/2015] [Indexed: 11/10/2022]
Abstract
Atypical hernias are difficult to diagnose due to their rarity and often unspecific symptoms. In the literature there exist hints to peri-inguinal hernias, i.e. direct lateral hernia, but most of them are forms of Spigelian hernias. Since the majority were described during the first half of the past century or even earlier, only very few cases have been documented using modern diagnostic techniques. We report a unique case of a 51 year old patient presenting with an atypical inguinal hernia with concomitant inguinal and umbilical hernias in combination with cystic kidney disease and intracranial aneurysm. The atypical position of the hernia was assumed from clinical inspection, ultrasound and CT scan and verified during pre-peritoneoscopy. Using an anatomical cadaver dissection approach, we followed the unusual position of the hernia through the abdominal wall below the aponeurosis of the external oblique muscle. After a thorough literature search, we assume that the present hernia containing a hernial sac has not been documented before, especially not in such a multidisciplinary approach comprising radiological, surgical and anatomical localisation and endoscopic treatment in a patient with a clinical situation being aggravated by large cystic kidneys leading to dialysis-dependency. Rare hernias have been described as being often associated with concomitant inguinal or other hernias, a predisposition for the male gender and a pathogenic mechanism related to other soft tissue defects such as cystic kidney disease or cranial aneurysm. Thus, we consider this a unique case that has not been documented in this constellation previously, which may increase the awareness for these rare hernias.
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Affiliation(s)
- László Veréb-Amolini
- Department of Surgery, Waid Hospital, Tièchestrasse 99, Zürich, CH-8037 Switzerland
| | - Thomas Betschart
- Department of Radiology, Waid Hospital, Tièchestrasse 99, Zürich, CH-8037 Switzerland
| | - Emilia Kiss
- Department of Radiology, Waid Hospital, Tièchestrasse 99, Zürich, CH-8037 Switzerland
| | - Oliver Ullrich
- Institute of Anatomy, University of Zürich, Winterthurerstrasse 190, Zürich, CH-8057 Switzerland
| | - Stefan Wildi
- Department of Surgery, Waid Hospital, Tièchestrasse 99, Zürich, CH-8037 Switzerland
| | - Elisabeth Eppler
- Institute of Anatomy, University of Zürich, Winterthurerstrasse 190, Zürich, CH-8057 Switzerland ; Institute of Neuroradiology, University Hospital, Otto-von-Guericke-University, Leipziger Strasse 44, Magdeburg, D-39120 Germany ; Current address: Department of Anatomy II, Friedrich Alexander University Erlangen-Nürnberg, Erlangen, D-91054 Germany
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Moreno-Egea A, Campillo-Soto Á, Morales-Cuenca G. Which should be the gold standard laparoscopic technique for handling Spigelian hernias? Surg Endosc 2014; 29:856-62. [PMID: 25060686 DOI: 10.1007/s00464-014-3738-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 07/08/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND The advantages and disadvantages of both extraperitoneal and intra-abdominal laparoscopic Spigelian hernia repair are still being discussed. To our knowledge, no study has compared both techniques in terms of safety, feasibility, and cost-effectiveness. METHOD Prospective data were collected to compare the results of the extraperitoneal approach with the intra-abdominal approach in laparoscopic Spigelian hernia repair, between 2000 and 2012 (n = 16). Diagnosis was confirmed preoperatively by ultrasonography and/or tomography. RESULTS Spigelian hernias occur mostly in women (69 %), on the left side (56 %) and at a median age of 62 (range: 38-83). In our study, the extraperitoneal technique was performed in seven patients, while the intra-abdominal approach was indicated in nine. No complications, re-admissions, or recurrences were detected in either during a mean follow-up of 48 months (range: 18 months-9 years). The statistical study showed that there was no difference in either morbidity or the recurrence rate between a totally extraperitoneal (TEP) and an intraperitoneal onlay mesh (IPOM) repair. The mean duration of an IPOM repair was, though, shorter than that of a TEP repair (30 vs. 48 min, P = 0.06). The combined fixation technique (tacks + glue) did not modify the results but did reduce the costs, as shown in the cost-effectiveness study where the intra-abdominal approach was cheaper (1260 vs. 2200 euros, P < 0.001). CONCLUSION Laparoscopy seems to be a safe and feasible technique whichever the approach chosen, be it intra or extraperitoneal. Our experience shows that intra-abdominal laparoscopic Spigelian hernia repair should be recommended as the gold standard because of its technical and economic advantages. The IPOM procedure with a lightweight titanium-coated mesh fixed using a combined technique is a highly effective option for Spigelian hernia repair.
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Affiliation(s)
- Alfredo Moreno-Egea
- Abdominal Wall Unit, Department of Surgery, Morales Meseguer University Hospital, Avda Primo de Rivera 7, 5ºD, 3008, Murcia, Spain,
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Shih YC, Sun HP. Spigelian hernia showing itself as a left lower abdominal mass. FORMOSAN JOURNAL OF SURGERY 2014. [DOI: 10.1016/j.fjs.2013.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Barnes TG, McFaul C, Abdelrazeq AS. Laparoscopic Transabdominal Preperitoneal Repair of Spigelian Hernia—Closure of the Fascial Defect Is Not Necessary. J Laparoendosc Adv Surg Tech A 2014; 24:66-71. [DOI: 10.1089/lap.2013.0407] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Thomas G. Barnes
- Colorectal Unit, Department of Surgery, Warrington & Halton Hospitals NHS Foundation Trust, Warrington, United Kingdom
| | - Chris McFaul
- Colorectal Unit, Department of Surgery, Warrington & Halton Hospitals NHS Foundation Trust, Warrington, United Kingdom
| | - Ayman S. Abdelrazeq
- Colorectal Unit, Department of Surgery, Warrington & Halton Hospitals NHS Foundation Trust, Warrington, United Kingdom
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