What is the recommended treatment for a spigelian hernia?

From the Guidelines

The recommended treatment for a spigelian hernia is prosthetic repair, as it is the treatment of choice for most abdominal wall complicated hernias, including spigelian hernias, according to the most recent evidence 1.

Key Considerations

• Spigelian hernias are prone to complications such as incarceration or strangulation due to their anatomical location between muscle layers.
• Surgical repair can be performed using either an open technique or laparoscopic approach, with the latter becoming increasingly preferred due to faster recovery times and less post-operative pain.
• Mesh repair is generally favored for adult patients as it provides tension-free closure and reduces recurrence rates, as supported by guidelines that recommend the use of mesh in clean surgical fields (CDC wound class I) for a lower recurrence rate without an increase in wound infection rate 1.

Surgical Approach

• The choice of surgical approach depends on the presence of complications such as intestinal strangulation or bowel resection.
• For patients with intestinal strangulation and/or concomitant need of bowel resection without gross enteric spillage (clean-contaminated surgical field, CDC wound class II), emergent prosthetic repair with synthetic mesh can be performed without an increase in 30-day wound-related morbidity and is associated with a significant lower risk of recurrence 1.
• Diagnostic laparoscopy may be a useful tool to assess bowel viability after reduction of complicated hernias 1.

Post-Operative Care

• Post-operative care includes pain management with acetaminophen or NSAIDs, avoiding heavy lifting (over 10 pounds) for 4-6 weeks, and monitoring for signs of infection or recurrence.
• Patients typically return to light activities within 1-2 weeks and full activities within 4-6 weeks.

Conclusion is not allowed, so the answer just ends here.

From the Research

Treatment Options for Spigelian Hernia

• Spigelian hernias can be treated using both laparoscopic and open repair approaches, with current guidelines validating both methods 2.
• Laparoscopic repair is often favored due to lesser postoperative complications and shorter hospital stay, regardless of the technique used 2, 3.
• Mesh repair is generally advised for Spigelian hernias, with various types of meshes available, including expanded polytetrafluoroethylene-coated and polyvinylidene fluoride-coated polypropylene meshes 3, 4.

Recommendations for Treatment

• All diagnosed Spigelian hernias should be planned for elective operation to prevent strangulated hernia and emergency surgery 2, 4.
• Both open and laparoscopic Spigelian hernia treatment can be safely performed, depending on the surgeon's experience 2, 5.
• Laparoscopic repair of Spigelian hernias is a safe and acceptable method, with various techniques available, including intraperitoneal onlay mesh technique 3, 6.

Outcomes and Complications

• The overall recurrence rate for Spigelian hernia repair is very low, with minimal complications and recurrences reported in all techniques 2, 6.
• Ninety-day readmission, 90-day reoperation, and long-term operation for recurrence rates are comparable between open and laparoscopic, and elective and emergency repairs 5.
• Emergency repair is often necessary, with 16% of Spigelian hernia repairs being done in the emergency setting 5.