Laparoscopic correction of Spighelian hernia
Spigel was a Flamish anatomist and botanist who was born in Brussels in 1578 an died in Padua, Italy, in 1625. His name is also written in the following ways: Spieghel, Spigel, Adrianus Spigelius, Spiegelius, Adriano Spigeli.
The hernia of Spigel is a uncommon hernia at the outer rim of the rectus muscle below the level of the umbilicus. The complaints are mostly vague because of which it is difficult to recognize.
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In this case there were complaints for several years in the right lower abdomen and a clearly palpable swelling was present(1). A ct-scan shows the hernia very well as well as the defect between the rectus and oblique muscles (2).
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A laparoscopy is performed. The fatty tissue can be clearly seen, bulging through the defect (3). This tissue is withdrawn and then the defect is very well visible (4). After removing fatty tissue from the abdominal wall around the defect a prosthesis is introduced (5) to cover the defect.
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The prosthesis is fixed through the abdominall wall with four stitches and besides this with staples (6,7). Picture 8 shows the outer borders of the hernia and with the smaller circle the size of the defect. The lightblue arrows indicate the position of the used workingports and the darkblue arrows indicate the place of the four transabdominal stitches.
A swelling can be present for several weeks after the operation because of fluid in the space of the former hernia. Eventually it will disappear.
Another example of a Spigelian hernia. In this case there was an acute bowel obstruction, necessitating an emergency operation.
