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Anatomical diagram showing the relationship between the rectus abdominis muscle (RA), transversus abdominis muscle (TA) and the spigelian fascia. The arcuate line and “Spigelian belt” are also shown
Source publication
Background:
Spigelian hernias are said to be a rare condition of the elderly population, usually arising below the arcuate line. Local experience has led us to challenge these commonly held beliefs.
Methods:
Operations for Spigelian hernia from 2006-2016 were identified from the Edinburgh Lothian Surgical Audit computerised database and case not...
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Citations
... In literature, case reports and case series predominate. Only five reviews with small numbers of patients (10 to 107) are available [6][7][8][9][10]. A recent database study from Denmark summarized 365 cases, with 16.4% being emergency interventions [11]. ...
Introduction
Spigelian hernias are among the rare primary ventral hernias. Diagnosis is often difficult, as many cases are asymptomatic. Spigelian and inguinal hernias are usually considered separately in current scientific literature. With this case series, we want to illustrate a possible relationship between the neighboring hernia types.
Methods
In this article, we report on a case series of Spigelian hernias that were operated on in five hernia centers in the period from January 1st, 2021 to October 31st, 2023. We have summarized all patient characteristics with previous operations and the result of the secondary operation.
Results
We report a case series with 24 Spigelian hernias, 15 of which have a connection to previous inguinal hernias. In these cases, however, it is not certain whether these are primarily overlooked or occult hernias or whether these Spigelian hernias have arisen secondarily, as a result of previous hernia surgery.
Summary
With this case series, we would like to point out a possible connection between Spigelian hernia and inguinal hernia. Further studies are needed to shed more light on this entity and explain its genesis.
... It was first described by Joseph Klinkosh in 1764 and is named after Adrian Van der Spieghel who first described the semilunar line. 1 While SH represents only 1%-2% of all ventral hernias, the true incidence remains unknown, as many patients remain asymptomatic. 2,3 However, SH carries a significant risk of incarceration-related complications (24%), which require immediate surgery, making early diagnosis crucial. 1 Adult females have a higher incidence of SH, with a female-tomale ratio of 2:1. 2 In particular, females who have undergone previous pregnancies or have any condition leading to increased intraabdominal pressure are at greater risk. 2,4,5 In abdominal pain for 1 year, associated with constipation. ...
... 2,3 However, SH carries a significant risk of incarceration-related complications (24%), which require immediate surgery, making early diagnosis crucial. 1 Adult females have a higher incidence of SH, with a female-tomale ratio of 2:1. 2 In particular, females who have undergone previous pregnancies or have any condition leading to increased intraabdominal pressure are at greater risk. 2,4,5 In abdominal pain for 1 year, associated with constipation. ...
... 2,3 However, SH carries a significant risk of incarceration-related complications (24%), which require immediate surgery, making early diagnosis crucial. 1 Adult females have a higher incidence of SH, with a female-tomale ratio of 2:1. 2 In particular, females who have undergone previous pregnancies or have any condition leading to increased intraabdominal pressure are at greater risk. 2,4,5 In abdominal pain for 1 year, associated with constipation. She had a medical history of multiple pregnancies and a cesarean section 25 years ago, with no other significant medical or surgical history. ...
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.
... The hernia may be easily reduced, but omentectomy or bowel resection may be required depending on the case, and a mesh is placed. The closure of the fascia can be done with either absorbable or non-absorbable sutures [6,7]. ...
Ventral hernias occur when abdominal contents or the peritoneum displace through a defect in the abdominal wall. Among these, spigelian hernias are an exceptionally rare subtype, representing 0.12% to 2% of all ventral hernias. This case study focuses on an 86-year-old female presenting with a ventral hernia, notably a spigelian hernia, lacking common predisposing factors. The study emphasizes the use of laparoscopic techniques for repair, aiming to offer insights into managing this infrequent hernia type and aiding clinical decision-making. Due to its low incidence and challenging diagnosis and identification, reports such as ours detailing both the clinical course and the operative steps can assist others in their clinical decision-making.
... Due to the difficulty of diagnosis, the rarity and the high rate of incarceration (27% of all cases), Spigelian hernias are of particular clinical concern [2,4,5,[9][10][11]. ...
... Clinical signs and symptoms are often vague and illdefined, with many cases being detected incidentally or presenting with undifferentiated, intermittent abdominal pain [9]. Only a small portion of patients have examination findings of a palpable, tender abdominal mass [2,11]. ...
... However, the recent advent of robotic technology introduces another alternative approach. Whilst there have been multiple studies comparing laparoscopic and conventional open techniques for repair of midline ventral hernias, there is still limited evidence on Spigelian hernia repair [9][10][11][12]. ...
Purpose
Spigelian hernias arise at the linear semilunaris and account for approximately 1–2% of abdominal hernias. The aetiology is due to a defect of the aponeurosis of the transverse abdominis and when discovered, management is surgical intervention. The aim of this study was to observe operative outcomes for open and minimally invasive repair.
Methods
A retrospective chart review was conducted at two hospitals in Townsville, The Townsville University Hospital and The Mater Private Hospital over a 10-year period (2010 to 2020). A surgical database search (ORMIS & IEMR) was performed at both locations using key search terms, including “spigelian hernia”, “laparoscopic”, “open”. Descriptive statistics were utilised to analyse patient factors and operative outcomes in the public and private setting.
Results
43 cases of Spigelian hernias (25 female, 18 male) were reported over the study period. The average age was 66. There were 36 elective cases and 7 emergency cases. A laparoscopic approach was the preferred method of repair, occurring in 74% of cases. Of these cases, the predominant hernial content was fat only. 65% of cases had a history of prior abdominal surgery unrelated to the “Spigelian belt” location. Complications occurred in 19% of cases. Other variables, such as ethnicity, smoking status, defect size, predisposing factors and recurrence rate, were analysed and did not yield statistical significance.
Conclusion
Although a small sample size, the data suggest there is no statistically significant difference between operative outcomes, complication rate and predisposing factors between open and minimally invasive case groups.
... They can present with mild manifestations with symptoms such as pain, a lump or even bowel obstruction. 3 These can be repaired by a minimally invasive or an open approach. Minimally invasive surgery (MIS) is the surgical technique of choice, as described by Palanivelu who demonstrated mesh reinforcement after primary suture closure. ...
... Los bordes de la aponeurosis de Spiegel están limitados por el músculo recto medialmente y la línea semilunar lateralmente. Estas hernias ocurren con mayor frecuencia en el área ubicada por debajo del ombligo hasta el plano interespinal, que se encuentra entre las espinas ilíacas anteriores superiores derecha e izquierda y se conoce comúnmente como el "cinturón de hernia de Spiegel" (1). ...
Se presenta el caso de un paciente masculino de 26 años, con cuadro de dolor abdominal, ausencia de deposiciones, intolerancia a la vía oral y picos febriles, que dado lo bizarro del cuadro clínico de ingreso, fue mal enfocado en los servicios de urgencias como constipación e infección de vías urinarias, finalizando en resolución quirúrgica de su cuadro herniario atípico.
... Scoping reported the first case in the pediatric age group in 1935, which is known as a "spontaneous lateral ventral hernia" or "hernia of the semilunar line." Its incidence is variable and quoted range in the literature is 0.1-2% [3][4][5]. Most commonly, it occurs on the right side and has a slight predilection for females (ratio: 4:3). ...
A Spigelian hernia occurs through a slit-like defect in the anterior abdominal wall lateral to the rectus abdominis muscle at the semilunar line in the lower quadrant of the abdomen where the posterior sheath is deficient. Due to atypical, vague, and widespread signs and symptomology, the diagnosis is always a challenging issue misleading for surgeons. Thus, a logical and high sense of suspicion is the need of the hour for diagnosing it at the early possible time, with the most common location of the lump being in the semilunar line. Once diagnosed, management is operative or else complications such as incarceration and strangulation are not uncommon. Surgical management may be conventional open or minimally invasive laparoscopic depending on the availability of expertise. We present a case of a Spigelian hernia in a lady who presented with intermittent pain in the left side of the lower abdomen for the past 8 years and was being treated symptomatically at various hospitals after being diagnosed with psychosomatic pain. She was diagnosed at our center and managed by laparoscopic mesh repair.
... [12] As adults contain an abundance of abdominal fat, the diagnostic challenges increase. In comparison, the scarcity of fat in children enables a quicker diagnosis [14]. Only about 50 % of Spigelian hernias are diagnosed preoperatively. ...
Introduction:
Spigelian hernia is an uncommon hernia presenting as a protrusion of abdominal contents through the spigelian fascia, lateral to the rectus abdominis. In some rare cases, Spigelian hernia can occur alongside cryptorchidism, which forms a recognized syndrome found in male infants with Spigelian hernia. This is a relatively unreported syndrome with very limited literature available regarding it, none of which is reported in Pakistan in adults.
Presentation of case:
We report a case of a 65-year-old male with right sided obstructed spigelian hernia along with the rare finding of testis in the hernial sac. The patient was successfully managed by transperitoneal primary repair (herniotomy) with orchiectomy. The patient recovered uneventfully and was discharged 5 days after the surgery.
Discussion:
The exact pathophysiology of this syndrome remains unclear. Three theories have been proposed to explain this syndrome, including the primary defect being Spigelian hernia leading to undescended testes (Al-Salem), testicular maldescent preceding the formation of the hernia (Raveenthiran), or the absence of the inguinal canal leading to the development of a rescue canal due to the undescended testes (Rushfeldt et al.). In this case, the absence of gubernaculum was confirmed suggesting the findings to be consistent with Rushfeldt's theory. The surgical team proceeded with hernial repair and orchiectomy.
Conclusion:
In conclusion, Spigelian-Cryptorchidism syndrome is a rare syndrome in adult male, with an unclear pathophysiology. Management of this condition involves repair of the hernia along with either orchiopexy or orchiectomy, depending upon the risk factors involved.
... Given this low incidence, they often present a diagnostic dilemma for the clinician and frequently lead to a delay in treatment or the need for emergent surgery [4,9]. As well given their relatively rare nature, true patient and hernia characteristics are unknownincluding patient demographics and co-morbidities, as are optimal treatment approaches [1,[9][10][11][12][13]. ...
... Studies completed to date have been case reports and small case series, with a single small Randomized Control Trial (RCT) encompassing 22 patients and a larger more recent cases seriesfocusing solely on operative techniques [6,[11][12][13]. Furthermore, the European Hernia Society (EHS) and American Hernia Society (AHS) have published a position paper as to the preferred treatment approaches, acknowledging a lack of data to suggest such a recommendation [1]. ...
... At this center which focuses solely on hernias, the overall incidence of Spigelian hernias was 0.139 %. This is on the lower end of previously published results [7,13]. Two of the more common explanations for this include a possible misattribution previously of all lateral ventral hernias as true Spigelian hernias and, given our study focused on scheduled rather than emergent hernia repairs we have undoubtedly omitted a subset of patients who presented in an emergent manner. ...
Purpose:
The objective of this study was to evaluate a high-volume hernia center's experience with primary Spigelian hernias.
Introduction:
Spigelian hernias are rare entities presenting a diagnostic dilemma for clinicians that often lead to a delay in treatment or need for emergency surgery. Given this low incidence true patient and hernia characteristics are unknown.
Methods:
This was a retrospective chart review evaluating patients who underwent a Spigelian hernia repair between 2005 and 2019. Descriptive statistics were utilized.
Results:
The incidence of Spigelian hernias at our institution was 0.14 %. There were 141 patients with 143 spigelian hernias (two patients had bilateral hernias) repaired at our institution during the study period, the majority of these were in male patients, left sided and repaired under conscious sedation with or without the use of mesh.
Conclusion:
This study adds a large dataset to the paucity of literature that exists in the context of Spigelian hernias and alerts the clinician that these hernias are not exclusive to the older female population. Furthermore, this study provides the need for a high index of suspicion in patients presenting with vague abdominal pain who may not fit the typical Spigelian hernia mold.
... Las principales quejas de los pacientes son el compromiso estético y el dolor abdominal, seguido por manifestaciones cutáneas y limitación para diferentes actividades de la vida diaria. Sin embargo, existe el riesgo de presentar condiciones que amenazan la vida, como la incarceración y la estrangulación de la hernia, que puede ocurrir hasta en el 15 % de los pacientes 4,7 , llevando a obstrucción, necrosis e inclusive perforación intestinal 8,9 . ...
Introducción. El objetivo de este estudio fue describir las características de la población y determinar las principales complicaciones de los pacientes que son llevados a cirugía por hernia lateral en el abdomen.
Métodos. Estudio observacional retrospectivo, que incluyó a los pacientes sometidos a herniorrafia lateral, entre 2015 y 2019 en un centro de tercer nivel. La información se obtuvo del registro de historias clínicas. Las variables analizadas se clasificaron según las características sociodemográficas de los pacientes, clínicas y quirúrgicas. Se hizo una caracterización de acuerdo con los resultados encontrados.
Resultados. Se incluyeron 51 pacientes con hernia lateral, 29 de ellos mujeres, con un promedio de edad de 59 años y de índice de masa corporal de 28 kg/m2 . El 60 % tenía comorbilidades de base, siendo la hipertensión arterial la más frecuente. La mayoría se clasificaron como ASA II. En cuanto a la localización, la L3 fue la más común (37,2 %). Se presentaron complicaciones postquirúrgicas en el 27,4 % de los pacientes, siendo las más frecuentes seromas, hematomas e infecciones de sitio operatorio. Ningún paciente requirió reintervención para el manejo de las complicaciones.
Conclusión. Conocer la población y determinar cuáles son las principales complicaciones postquirúrgicas de un procedimiento permite tomar medidas para disminuir su frecuencia, pero en este caso, se necesitan estudios adicionales para determinar cuáles son los mayores factores asociados a las complicaciones.
