[Diagnosis and treatment of Spigelian hernia]
Martin Louring-Andersen1, Flemming Pii Hjørne, Jan Skovdal
1Kirurgisk Afdeling, Køge Sygehus, DK-4600 Køge, Denmark. louringandersen@gmail.com
Introduction:
Spigelian hernia is a rare condition, which is frequently difficult to diagnose. This study describes our experience and we briefly discuss our findings in relation to the sparse literature.
Material And Methods:
Seven-year retrospective study (2000-2006) with prospective follow-up in a consecutive series of patients.
Results:
We identified a total of 12 patients with 13 spigelian hernias among 379 patients with ventral hernia (3.1%). Symptoms and clinical findings varied substantially between patients. Due to strangulation, four patients underwent acute operation and eight patients underwent elective operation (laparoscopic (n = 7); open (n = 1)). One patient was treated conservatively. After a median of 3.3 years (range 0.8 to 6.8 years) recurrence was found in one patient and one patient (without recurrence) had moderate pain at the former hernia site.
Discussion:
Due to the relatively high risk of strangulation, all patients with spigelian hernias should be offered surgery regardless of symptoms. Pain and perhaps bulging at the semilunar line indicates a spigelian hernia, but the diagnosis can be difficult to establish. When in doubt, we suggest the use of computed tomography and, subsequently, diagnostic laparoscopy and laparoscopic repair.
