Diagnosis and treatment of Spigelian hernia
Louring-Andersen, M.; Hjørne, F.P.; Skovdal, J.; Bisgaard, T.
Ugeskrift for Laeger 171(48): 3518-3522
2009
ISSN/ISBN: 1603-6824 PMID: 19944051 Document Number: 633729
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. Seven-year retrospective study (2000-2006) with prospective follow-up in a consecutive series of patients. 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. 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.