Spigelian hernia (SH) is uncommon and accounts for only 0.12–2% of all abdominal hernias. Spigelian hernia is a protrusion through a defect in the aponeurosis of the transversus abdominis muscle (Spigelian fascia) that is limited by the semilunar line and the lateral edge of the rectus abdominis muscle. It is more common in women 50–60 years and it is twice as common on the right side. Patients may present with non-specific abdominal pain. Clinical diagnosis may be difficult, especially in obese patients, and radiologic exams are essential to obtain the correct diagnoses. This type of hernia has a mandatory indication to surgical repair due to the risk of incarceration that can occur in about 25% and strangulation that can occur in about 40%. Traditionally, open surgical repair is most commonly used. However, laparoscopic approach is becoming increasingly popular since it allows faster recovery, shorter hospital stay, and less pain, with no commitment to recurrence. Currently, there are no studies that demonstrate the superiority of a laparoscopic technique (intraperitoneal onlay mesh (IPOM), transabdominal pre-peritoneal (TAPP) or extraperitoneal approach (TEP)). The intraperitoneal route is a simple, faster, and easily reproducible approach.
Part of the book: Hernia Surgery