Spigelian Hernia

What is Spigelian Hernia?

The layer between the semilunar line and the rectus abdominis muscles is known as Spigelian fascia. When a hernia develops in this layer, it is termed as a Spigelian hernia. It is a condition where the peritoneal fat or sac of an organ protrudes out when the Spigelian fascia is either weak or suffers from a congenital disability.

Is Spigelian Hernia easy to detect?

A Spigelian hernia has little signs of outward swelling as it affects the muscles of the abdominal wall. Thus it is very difficult to detect and treatment is usually offered much later. This type of a hernia may occur due to the weakening of the abdominal wall, injury, prolonged periods of physical stress, etc.

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Causes of Spigelian Hernia

• Obesity: Overweight people are burdened with excess fat and at times the muscles are unable to bear the strain and may subsequently become weak. Moreover, the location of a Spigelian hernia is such that it makes it even more difficult to be detected and surgically treated in obese people.
• Physical Strain: Any physical work requires core strength. Heavy labor or strenuous exercise may build pressure on the abdominal area and could result in a Spigelian hernia.
• Urinary Retention and Constipation: People suffering from urinary retention suffer from a sense of incomplete voiding and poor flow, while those who suffer from constipation have difficulty in passing bowels. In such conditions, the concerned individual feels the need to exert more pressure than is normally required to urinate or pass bowels.
• Trauma or Injury: A Spigelian hernia could be a result of trauma or injury that an individual may have experienced in the past. People often get injured in a way that takes a very long time to heal or may not be able to heal fully throughout their lifetime. Complications may occur even if little pressure is exerted on the abdominal region.
• Coughing, Sneezing, and Vomiting: All the three bodily reactions cause a jerk in the entire system. Repeated coughing, sneezing or vomiting strains the abdominal region the most and can be a cause of a hernia.
• Heredity: Hernia is connected to weak connective tissues due to genetic traits that are transferred from one generation to the next.
• Pregnancy: Women who have given birth to two or more offsprings are known as multiparous women. Mass is found along the linea semilunaris or a focal tenderness is observed that might lead to strangulation and problems in bowel movement resulting in the development of a hernia.

Symptoms of Spigelian Hernia

• Localized pain reoccurs from time to time
• Obstruction in the digestive paths & intestines
• Obstruction of bowels
• Nausea
• Vomiting
• Small protrusion in the abdominal area (may or may not be easily visible)
• Maybe soft to touch in people with little body fat
• Difficulty in standing for prolonged period or when lifting heavy weights
• Lump appears when the patient is upright & disappears while lying down
• Indigestion

Tests for Spigelian Hernia

• Computed tomography is conducted to show the numerous angles with diverse dimensions
• Ultrasound produces high-frequency waves to produce images
• Magnetic resource imaging to find a contract between body tissues and detect the problem
• The following tests are performed to check if the individual is suited to undergo surgery:
• Cardiogram
• Blood test
• X-ray

Treatment for Spigelian Hernia

A spigelian hernia needs to be surgically removed before it causes complications such as strangulation of other organs, obstruction of bowel movement and blood supply. There are two kinds of surgery that are proposed in case of a hernia:

Open Hernia Surgery

1. A long incision is made in the abdomen near the site of the defect
2. Before using a mesh underlay or sutures to repair the problem in the abdominal wall, the tissues and organs are returned to their proper locations
3. Patient can return to normal activities within three weeks and may resume strenuous activities after six weeks

Laparoscopic Hernia Repair

1. Laparoscopic hernia repair is a minimally invasive procedure where a thin scope with a camera attached to it is inserted to obtain internal visibility of a hernia and its surrounding structures
2. A small incision is made to expose and repair the defected area of the abdominal wall using a mesh or sutures. Less discomfort and pain is experienced in this procedure as compared to open hernia surgery
3. Recovery period is also shorter in this case and the patient can resume light work after one or two weeks and strenuous activities after four weeks

Various Surgical Approaches

• Endoscopic approaches: Abdominal access is obtained by using a Veress needle to identify the site affected. Ports are placed at least 10 cm away from the site of the defect in the form of an arc or circle and the defect is placed at the center. Contents from the sac are removed and in case a synthetic mesh is required, adhesiolysis is performed to get an overlap of 5 cm around the defect.
• Total Extraperitoneal Repair: Three midline ports are used to perform the endoscopic total extraperitoneal repair. Extraperitoneal space is created by using a balloon and creating an open access. A hernia is identified and removed completely. To make sure mesh overlaps, the peritoneum is dissected above the arcuate line maintaining a 5 cm margin from the defect. The mesh is then fixed to the anterior abdominal wall using spiral tacks.
• Conventional Approach: An incision is made above the protrusion. The peritoneal sac is exposed by making an incision in the external oblique aponeurosis in the direction of its fibers. Commonly, the sac has been reported to contain omentum and is simply inverted.
• Transabdominal Preperitoneal Repair: First the contents of the hernia sac are reduced, and the peritoneal flap is raised to reduce the hernia sac completely. The peritoneal sac is dissected 5 cm around the hernia defect. A mesh is placed in the extraperitoneal space and fixed using tacks or sutures.

When to visit Doctor?

Spigelian Hernia is a serious health condition that requires immediate medical assistance. The fact that it is difficult to detect makes it even more difficult to treat it at the appropriate time. If left untreated, it may cause further complications that could be life-threatening. Thus, a doctor must be consulted to diagnose the condition as soon as possible.