The diagnosis of a spigelian hernia is difficult few surgeons suspect it, it has no characteristic symptoms, and the hernia may be interparietal with no obvious mass on inspection or palpation. The hernial sac, surrounded by extraperitoneal fat, is often interparietal passing through the transversus and the internal oblique aponeuroses and then spreading out beneath the intact aponeurosis of the external oblique, or lying in the rectus sheath alongside the rectus muscle. The hernial ring is a well-defined defect in the aponeurosis. The spigelian aponeurosis is widest between 0 and 6 cm cranial to the interspinous plane and 85-90% of the hernias occur within this вЂњspigelian herniaвЂќ belt. Spigelian hernia has been described as a complication of chronic ambulatory peritoneal dialysis (CAPD). Spigelian hernia may be related to stretching in the abdominal wall caused by obesity, multiple pregnancies, previous surgery or scarring. Perforating vessels may weaken the area in spigelian fascia and a small lipoma or fat enters here which gradually leads to hernia formation. Spigelian hernia can be congenital or acquired.

Spigelian hernias are very uncommon and constitute only 0.12% of all abdominal wall hernias. The hernia appears to peak in the 4 th to 7 th decades. However, the hernia was first described by Klinkosch in 1764. Spigelian hernia is named after Adriaan van Spieghel, who described the semilunar line. The advantage of TEP approach is that it eliminates the complications related to violation of peritoneal layer to reach the preperitoneal space. Total extraperitoneal repair (TEP) of spigelian hernia has also been reported in literature. Most of the time when laparoscopy has been used as a treatment modality for spigelian hernia it has been done by transabdominal approach. The spigelian hernia has been repaired by both conventional and laparoscopic approaches. The hernia may be interparietal with no obvious mass on inspection or palpation. The diagnosis of spigelian hernia is difficult. The hernia ring is a well-defined defect in the transversus aponeurosis.

It is also called вЂњspontaneous lateral ventral herniaвЂќ or вЂњhernia of semilunar lineвЂќ. Most of spigelian hernias occur in the lower abdomen where the posterior sheath is deficient. Spigelian hernias occurs through slit like defects in the anterior abdominal wall adjacent to the semilunar line which extends from the tip of the ninth costal cartilage to the pubic spine at the lateral edge of the rectus muscle inferiorly. There were no recurrences, or other morbidity at mean follow up period of 3.2 years (range 6 months to 10 years). In six patients (6/10) we performed an intraperitoneal onlay IPOM repair, in two patients (2/10) transabdominal preperitoneal repair (TAPP), and in two (2/10) total extraperitoneal repair (TEP). Eight patients (8/10) presented with abdominal pain and two patients (2/10) were asymptomatic. We retrospectively reviewed our experience of ten patients between 19. There have also been case reports of management of spigelian hernia by total extraperitoneal approach. Most of the authors have managed it by transperitoneal approach either by placing the mesh in intraperitoneal position or by raising the peritoneal flap and placing the mesh in extraperitoneal space. Laparoscopic management of spigelian hernia is well established. The spigelian hernia has been repaired by both conventional and laparoscopic approach. It has been estimated that it constitutes 0.12% of abdominal wall hernias. Spigelian hernia is in itself very rare and more over it is difficult to diagnose clinically. The hernial sac, surrounded by extraperitoneal fatty tissue, is often interparietal passing through the transversus and the internal oblique aponeuroses and then spreading out beneath the intact aponeurosis of the external oblique.

The hernia ring is a well-defined defect in the transverses aponeurosis. Spigelian hernia occurs through slit like defect in the anterior abdominal wall adjacent to the semilunar line.

Low spec experience review