A Spigelian hernia is a protrusion through the 'spigelian fascia'. The hernia is noticed at the border of the rectus abdominis muscle and arcuate line, identified as the mid point of an imaginary line drawn from belly button to the hipbone. Clinically it is not easy to diagnose and my present with pain just next to and below the umbilicus.
Who commonly presents with it?
Spigelian herniae are rare, occur later in life (ages 40 and above) and are more common in patients that are overweight. They can also occur after pregnancy.
How does it present?
A spigelian hernia is usually noticed as a lump on the abdomen. It can be painful on coughing and present with a tender non-reducible lump (incarcerated or strangulated hernia) in which case it is a possible surgical emergency, which is more common with spigelian hernias. The hernia though usually contains fat overlying the bowel (extraperitoneal fat). It is diagnosed by simple examination, but may also require an ultrasound or CAT scan.
What can be done?
Most patients require surgical repair as the hernia may become incarcerated or strangulated. Surgery involves an incision over the lump and closure of the defect. A mesh is used only if the defect is large. Surgery requires a general anaesthetic. In some cases especially if the hernia is painful but difficult to diagnose a keyhole approach is preferred and can also be helpful in larger (obese) patients. The keyhole approache can be undertaken as either full laparoscopic or endoscopic where the surgeon goes between the abdominal wall layers.
How long will your recovery take?
Recovery does not take long, with most patients being discharged the same day or with one night stay only for both open and keyhole approach. Complete recovery is based on individual needs and fitness of the patient. Patients are encouraged to start mobilising gently and immediately after surgery and also to refrain from lifting heavy objects for at least two weeks. A return to full activities is expected within 4 weeks.
What are the main risks of surgery?
Your surgeon will advise on any specific complications and risks. For all types of surgery there is always a risk of wound infection and a 1-2% risk of recurrence of the hernia as well as bowel and other organ injury.