Spigelian hernia: Diagnosis and treatment

Purpose: Spigelian hernia is a rare type of ventral hernia that may develop anywhere in the area between the lateral border of the rectus abdominis muscle and medial border of the transversus abdominis muscle from the 9. costal cartilage to the pubis. Materials and Methods: This retrospective study reviews 6 patients operated on for a Spigelian hernia, evaluating the age, sex, body-mass index, co-morbidity, clinical presentation, localization, size of the defect, duration of hospitalization and surgical techniques. Results:</b< All of the patients operated on were female with a mean age of 48 (35-70). Average body-mass index was 29.4 (25-34). Chronic constipation was present in two patients and chronic obstructive pulmonary disease in one. Two patients simultaneously had pfannenstiel incisional hernia, one had umbilical hernia and one had inguinal hernia on the same side. The Spigelian hernia was situated on the right side in 4 patients and on the left in 2. Average size of the defect was 3 (2-5) cm. All the patients reported pain and a palpable mass. The interval between the onset of symptoms and diagnosis varied from 2 to 9 years with an average of 4 years. All of the hernia defects were treated with mesh herniorraphy techniques. During the follow-up of 2-50 months no recurrence was observed. Conclusion: Spigelian hernias are rare and often occur with other types of ventral hernias. It has to be differentiated from incisional and ventral hernias. Mesh herniorraphy techniques using polypropylene meshes have well long term outcome with low recurrence rates.