Spigelian hernia. Our experience and review of the literature

Abstract

BACKGROUND: Spigelian hernia is an uncommon and rare abdominal wall defect. We present our series of patients with Spigelian hernia and a literature review. 

METHODS: We carried out a retrospective review of patients operated on from 2005 to 2011 at Ondokuz Mayis University Medical Faculty Department of General Surgery. Epidemiological aspects, diagnostic methods, surgical techniques, morbidity, hospital stay, recurrences and follow up were analyzed. 

RESULTS: We have treated 9 patients, 7 female and 2 male, with a mean age of 64 (range 47-81) years. Right side was the most frequent location. Risk factors were present in 77.8% of patients. Diagnosis was made clinically in 7 of 9 cases but preoperative imaging was made in all patients for obtain detailed information about the defect. Open hernioplasty with polypropylene mesh placed over the external oblique aponeurosis constitutes the most frequent technique (44.5%) used by repair with a primary suturation (33.3%). The remaining 22.2% of cases were laparoscopic hernioplasty placing intraperitoneal position a mesh (22.2%). Mean hospital stay was 5.1 days (range 2-9), however if we look the laparoscopic cases the time decreased to 2.5 days. One recurrence was noted during the 15th month of follow-up, which has already been operated on. The mean follow-up period of this study was 58 months. No mortality was observed among patients. 

CONCLUSIONS: Spigelian hernia is rare and requires a high index of suspicion given the lack of consistent symptoms and signs. The physician should secure the diagnosis combining a proper history and physical examination with the preoperative imaging. Surgical technique depends on patient characteristics, type of hernia and surgeon experience.