Spigelian hernia develops due to the presence of a defect / aperture in the spigelian fascia, (it is the part adjacent to a muscle of abdomen called as rectus abdominis).
Spigelian hernias tend to be small and consequently the danger of strangulation is very high. Most hernias are known to develop on the right side and are usually seen in the 40 to 70 years age group.
What Causes A Spigelian Hernia?
A Spigelian hernia develops through a narrow opening / gap in the anterior wall of the abdomen flanking the semilunar line. Nearly all spigelian hernias develop in the lower portion of the abdomen, wherein there is a lacking of the posterior sheath. The hernia ring is a distinct defect / aperture in the aponeurotic layer.
The sac of the hernia, engulfed by extra peritoneal fatty tissue, is habitually inter parietal and passes through the transversus and the internal oblique aponeuroses and then spreads beneath the external oblique aponeurosis.
Spigelian hernia is extremely uncommon and rather tricky to diagnose.
Symptoms Of Spigelian Hernia
A spigelian hernia may or may not show any presenting features. Occasionally the hernia may be silent. Sometimes, the hernia may be captured on an ultrasound when examining the person for some other complaint.
Manifesting features and clinical symptoms of spigelian hernia, when they are present include:
- The patient typically complains of the presence of an intermittent and sporadic lump / mass in the lower portion of the abdomen, invariably below the umbilicus.
- The mass will be very small, since a spigelian hernia tends to be very tiny in size and has a narrow neck to the hernia sac.
- There will be localized pain and discomfort.
- Occasionally, there may be a few signs of bowel occlusion.
Your doctor will order a CT scan or an ultrasound exam to make an accurate diagnosis of your symptoms.
How To Repair A Spigelian Hernia?
Prompt diagnosis and quick and appropriate treatment are always vital aspects of the prognosis of a case. A spigelian hernia must be repaired since it is prone to strangulation; luckily, the surgery is somewhat uncomplicated, with large defects calling for mesh prosthesis.
Your doctor will opt for either the Conventional technique to manage the hernia; or an Endoscopic technique or Trans-abdominal peritoneal technique.
Evidence shows that endoscopy – laparoscopy results have lesser morbidity and also need shorter hospitalization compared to the conventional open techniques to manage hernia. Mesh free laparoscopic repair is practicable and not dangerous. This technique to manage small Spigelian hernias offers the advantages of laparoscopic localization, cutting of the sac of the hernia, and closing without any morbidity.
Some doctors also advocate the trans-peritoneal approach – either by placing the mesh in the intra-peritoneal spot or by raising the peritoneal flap and placing the mesh in the extra-peritoneal gap. By and large, surgical intervention shows no recurrences or any other morbidity during the follow up period of 3 years.