Spigelian hernia is a rare partial
abdominal wall defect. The frequent lack of physical findings along
with vague associated abdominal complaints makes the diagnosis elusive.
A retrospective review of Mayo Clinic patients was performed to find
all patients who had undergone surgical repair of a Spigelian hernia
from 1976 to 1997. Patients were scrutinized for presentation, work-up,
therapy, and outcome. The goal of this study was to obtain long-term
outcome. The study was set in a tertiary referral center. There were 76
patients in whom 81 Spigelian hernias were repaired. Symptoms most
commonly included an intermittent mass (n = 29), pain
(n = 20), pain with a mass (n = 22),
and bowel obstruction (n = 5). Five patients were
asymptomatic. Preoperative imaging was performed in 21 patients and
correctly diagnosed the hernia in 15. Spigelian hernias were repaired
by primary suture closure (n = 75), mesh
(n = 5), and laparoscopic (n = 1)
techniques. Eight patients (10%) required emergent operations.
Thirteen hernias (17%) were found to be incarcerated at the time of
the operation. Overall mean follow-up for the 76 patients was 8 years,
with three hernia recurrences identified. Spigelian hernia is rare and
requires a high index of suspicion given the lack of consistent
symptoms and signs. An astute physician may couple a proper history and
physical examination with preoperative imaging to secure the diagnosis.
Mesh and laparoscopic repairs are viable alternatives to the durable
results of standard primary closure. Given the high rate of
incarceration/strangulation, the diagnosis of Spigelian hernia is an
indication for surgical repair.