How long does it take to recover after a Spigelian hernia repair?
Length of stay will vary depending on the size and the complexity of the Spigelian hernia but usually two days. Your ability to drive a car is governed by being able to put your right foot on the brake pedal to perform an emergency stop without inhibition (automatic transmissions) or both feet on the clutch and brake pedals (manual transmissions). Avoidance of heavy lifting or straining for three months is recommended to allow the tissues to reach their maximal tensile strength and therefore reduce the risk of recurrence if a sutured repair has been performed, but like laparoscopic inguinal hernia repairs with mesh, only two weeks.
Spigelian hernias are rare and generally difficult to diagnose as they occur between muscle layers and cause a variety of non-specific symptoms. They occur at the outside edge of the rectus sheath (which contains the ‘six pack’ muscles) where it joins the three layers of abdominal muscles (the Spigelian aponeurosis). Approximately half way between the umbilicus and the pubic bone the rectus sheath thins considerably giving rise to potential defects. The precipitating factors are similar to those of inguinal hernias. However, other important contributory factors include ageing, weight loss and paralysis of the abdominal muscles. In its earliest form, Spigelian hernias contain only preperitoneal fat, very much like epigastric hernias.
What are the signs and symptoms?
The usual presenting features are abdominal pain, a swelling in the lower abdominal wall, or signs of incarceration with or with out signs of intestinal obstruction or blockage. The abdominal pain varies in type, severity and location depending on the content of the hernia. The pain can be exacerbated by forced raising of the intra-abdominal pressure such as straining or abdominal weight training and is relieved by rest. If a swelling is palpable it will be felt by the patient or the specialist along the outside line of the rectus sheath. Where a Spigelian hernia is suspected but no hernia is readily palpated, then CT or MRI scanning, and diagnostic 3mm laparoscopy may be helpful in determining the diagnosis.
Do Spigelian hernias need surgery?
Yes. The natural history of these types of hernia suggests that once the weakness is established, the hernia continues to enlarge and puts the patient at risk of incarceration and strangulation.
What are the surgical / treatment options?
Usually these hernias are small, so that repair with non-absorbable sutures is indicated without tension. However, a tension free open mesh repair can also be used where the defect is larger. For specialists with experience in laparoscopic inguinal hernia repair, this approach is ideally suited to repair with mesh since the Spigelian hernia is seen crossing the preperitoneal plane which is dissected in preparation for repair of groin hernias. As these hernias are rare, the method of repair will depend very much on the experience of your specialist.