HERNIAS DE LA PARED ABDOMINAL ZONAS DEBILES DE LA PARED ABDOMINAL 1. Hernia epigástrica. 2. Hernia umbilical. 3. Hernia. Objective: Spigelian hernia is an uncommon abdominal wall defect. La técnica quirúrgica dependerá de las características del paciente, la hernia y la. H. epigástrica. . TÉCNICA LAPAROSCÓPICA• visualizar el defecto de la hernia y la anatomía circundante con claridad y ampliación.
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Diagnosis of Spigelian hernia is basically clinic. Am Surg ; 74 8: A high index of suspicion and a thorough physical examination is needed to make a hermia diagnosis, although in doubtful cases it is advisable to perform a sonography or better a tomography. To conclude we stress that diagnosis and treatment of Spigelian hernias is still a controversial matter, basically for the varied and uncommon presentation. Spigelian hernias have a multidisciplinary interest and their diagnosis involves herniq specialities such us surgeons, radiologists and in some instances internists and gastroenterologists when the SP presents as abdominal pain syndromes.
However it was Klinkosch in who first described a spontaneous lateral ventral hernia at the level of Spieghel’s semilunar line 4. CT scan is the recommended investigational imaging study, moreover if laparoscopic approach is going quirurgiva be employed so that any hernia sac content can be properly identified 17,6.
Cir Esp ; 79 3: Open approach follows the usual principles of any hernia repair. Most of these hernias occur distal to the umbilicus, within the spigelian hernia belt or Spangen area which is a transverse band between the line joining both anterior superior iliac spines and a parallel line 6 cm cranial at the level of the umbilicus 1,2.
We present our series of patients with Spigelian hernia and a literature review. In those cases of diagnostic doubt is advisable to perform a sonography or tomography 13, The different options include primary closure or mesh repair in cases of atrophic aponeurosis, wide defect or recurrences.
Br J Surg ; When the hernia sac contents the bowel the patient can present with nausea, vomiting or altered bowel rhythm.
In our experience intraabdominal approach is easy to perform and gives good results. Rev Esp Enf Ap Digest ; We have treated 39 patients, 25 female and 14 male, with a mean age of 70 years.
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Ann Surg ; 6: We have used intra-abdominal modality in all cases and we do not have experience with totally extraperitoneal technique, although is the recommended by most authors.
Carter JE, Mizes C. Laparoscopic repair of spigelian hernia: Ultrasonography can establish the diagnosis but provides less specificity than CT scan as has quite false negatives in obesity patients. Alicia Ruiz de la Herna.
Hernias de Spiegel: Nuestra experiencia y revisión de la literatura
The treatment of Spigelian hernia should tecniva surgical. In these cases the hernia sac penetrates the external oblique aponeurosis and lie below the subcutaneous fat making easy during physical examination to feel the bulge.
Department of General Surgery I. Pain often can be provoked or aggravated by contraction of abdominal muscles or other hernix that increase the intra abdominal pressure 7and this can help us orienting the correct diagnosis.
Evaluation of spigelian hernia by CT. The first one allows to explore the contralateral side as well as the abdominal cavity and for some authors is the recommended method when there is another process requiring associated surgery because can be performed in the same intervention 6. Laparoscopy approach allowed us to explore abdominal cavity and rule out any damage to the bowel loops that could have passed unnoticed.
Rev Esp Enferm Dig ; The hernia location is unknown in 5 of our patients as the medical history didn’t include this information, which is a frequent limitation of retrospective studies. Am J Obstet Gynecol ; To date Spanish reports on this pathology are short series of cases, being the largest one published by Moreno-Egea et al in with 27 patients 5. Between January and December39 patients underwent surgery for Spigelian hernia.
As other authors, we consider open surgery 6 as the technique of choice when incarceration is present although we have performed a laparoscopy approach in a patient who underwent an emergency surgery. La morbilidad postoperatoria es escasa. Ugeskr Laeger ;