Spigelian Hernia: Surgical Anatomy, Embryology, and Technique of Repair

2006 ◽  
Vol 72 (1) ◽  
pp. 42-48 ◽  
Author(s):  
Panagiotis N. Skandalakis ◽  
Odyseas Zoras ◽  
John E. Skandalakis ◽  
Petros Mirilas
Keyword(s):  
Rectus Muscle ◽  
Abdominal Muscle ◽  
Surgical Anatomy ◽  
Spigelian Hernia ◽  
Etiologic Factor ◽  
Abdominal Muscles ◽  
Line Defects ◽  
Semilunar Line ◽  
Neonates And Infants ◽  
Wide Zone

Spigelian hernia (1–2% of all hernias) is the protrusion of preperitoneal fat, peritoneal sac, or organ(s) through a congenital or acquired defect in the spigelian aponeurosis (i.e., the aponeurosis of the transverse abdominal muscle limited by the linea semilunaris laterally and the lateral edge of the rectus muscle medially). Mostly, these hernias lie in the “spigelian hernia belt,” a transverse 6-cm-wide zone above the interspinal plane; lower hernias are rare and should be differentiated from direct inguinal or supravescical hernias. Although named after Adriaan van der Spieghel, he only described the semilunar line (linea Spigeli) in 1645. Josef Klinkosch in 1764 first defined the spigelian hernia as a defect in the semilunar line. Defects in the aponeurosis of transverse abdominal muscle (mainly under the arcuate line and more often in obese individuals) have been considered as the principal etiologic factor. Pediatric cases, especially neonates and infants, are mostly congenital. Embryologically, spigelian hernias may represent the clinical outcome of weak areas in the continuation of aponeuroses of layered abdominal muscles as they develop separately in the mesenchyme of the somatopleura, originating from the invading and fusing myotomes. Traditionally, repair consists of open anterior herniorraphy, using direct muscle approximation, mesh, and prostheses. Laparoscopy, preferably a totally extraperitoneal procedure, or intraperitoneal when other surgical repairs are planned within the same procedure, is currently employed as an adjunct to diagnosis and treatment of spigelian hernias. Care must be taken not to create iatrogenic spigelian hernias when using laparoscopy trocars or classic drains in the spigelian aponeurosis.

New data of topographic anatomy of semilunar line (semilunar line by A. Spiegel)

2021 ◽  
pp. 70-72
Author(s):  
A. V. Chernykh ◽  
M. P. Popova ◽  
V. Yu. Brigadirova
Keyword(s):  
Anterior Abdominal Wall ◽  
Abdominal Muscle ◽  
Spigelian Hernia ◽  
Diagnosis And Treatment ◽  
Body Type ◽  
Anatomical Dissection ◽  
Line Region ◽  
Semilunar Line ◽  
Location Type ◽  
Variant Anatomy

Background. Today, a special place in surgical practice is the treatment of patients with spigelian hernias, which can be subcutaneous, interstitial, prepperitoneal, and make up 1% of all external hernias of the abdomen. The difficulty in diagnosing of spigelian hernias can lead to a serious complication – infringement of the hernia, which will require emergency surgical treatment. Therefore, the study of the typical, sexual and variant anatomy of the Spigelian line region is important in improving the diagnosis and treatment of such patients.The aim. To study the features of typical, sexual and variant anatomy of the Spigelian line region.Materials and methods. We examined 42 non-fixed corpses of persons of both sexes without signs of pathology of the anterior abdominal wall. Among them were 26 (54.2%) men and 22 (45.8%) women. At autopsy, we performed anatomical dissection of the semilunar line region. We measured the width of the aponeurotic stretch from the end of the transverse abdominal muscle fibers to the lateral edge of the rectus abdominis muscle at level corresponding to d. bicostarum, umbilical ring and d. bispinarum.Results. We identified four clusters corresponding to the variations in the shape of the semilunar line: tapering down (9.5%), uniform wide (19.0%), tapering up (28.6%) and wide in the middle (42.9%). We found that the semilunar line, tapering up, was significantly more often observed in women (83.3%), uniformly wide – in brachymorphic body type (75.0%), wide in the middle – in mesomorphic body type (66.07%), and the semilunar line, tapering down, was found only in men. Variants of the shape of the semilunar line, tapering up or down, were absent in persons of the brachymorphic body type. Semilunar line, tapering up, was found (without significant differences) in persons of the mesomorphic body type in 41.6%, in the persons of the brachymorphic body type – in 58.4%, and semilunar line, tapering down, was noted in persons with a dolichomorphic body type in 75.0%.Conclusion. New data may allow to predict the location, type of spigelian hernia, and also improve the diagnosis and treatment of spigelian hernia.

Spigelian hernia-Our experience

JMS SKIMS ◽  
2019 ◽  
Vol 21 (2) ◽  
pp. 114-116
Author(s):  
Ajaz A Malik ◽  
Shams Ul Bari
Keyword(s):  
High Risk ◽  
Clinical Presentation ◽  
Spigelian Hernia ◽  
Abdominal Muscles ◽  
Medical College ◽  
Semilunar Line ◽  
Rare Hernia

Background; A Spigelian hernia is a very rare hernia which develops through the aponeurotic layer between the rectus abdominal muscles medially, and the semilunar line laterally. Aim: The aim of this study is to understand the clinical presentation and management of this rare hernia. Material and methods: This study was conducted over a period of five years in the Department of Surgery SKIMS Medical College Srinagar and included all the patients diagnosed as spigelian hernia. Results: During our study, we encountered only four cases of spigelian hernia, which included three females and one male. Conclusion: The spigelian hernia is a very rare hernia seen in adults and usually there is no notable swelling on examination. Although they are rare but there is a high risk of strangulation. JMS 2018: 21 (2):114-116

scholarly journals Spigelian hernia: a rare abdominal hernia

2018 ◽  
Vol 5 (12) ◽  
pp. 4078
Author(s):  
Sajid Hussain ◽  
Shakil Jawed ◽  
Zamurrad Parveen ◽  
Md. Asjad Karim Bakhteyar
Keyword(s):  
Abdominal Pain ◽  
Lower Abdominal Pain ◽  
Abdominal Wall Hernia ◽  
Rectus Muscle ◽  
Interesting Case ◽  
Spigelian Hernia ◽  
Abdominal Hernia ◽  
Port Site Hernia ◽  
Semilunar Line ◽  
Specific Symptoms

Spigelian hernia is a rare variety of abdominal wall hernia occurring through the spigelian fascia which is composed of the aponeurotic layer between rectus muscle medially and semilunar line laterally. Generally it is difficult to diagnose because of their location and non specific symptoms. Diagnosis is aided by ultrasonography and Computerized Tomography. Once the diagnosis is confirmed, it is repaired surgically as risk of incarceration is high. We reported this interesting case of spigelian hernia with associated port site hernia in a 53 year old female patient from Arwal district, Bihar who presented with occasional lower abdominal pain. The hernia was reduced and defect was repaired. Her recovery was uneventful.

Regional differences in abdominal muscle activity during various maneuvers in humans

1981 ◽  
Vol 51 (6) ◽  
pp. 1471-1476 ◽  
Author(s):  
K. P. Strohl ◽  
J. Mead ◽  
R. B. Banzett ◽  
S. H. Loring ◽  
P. C. Kosch
Keyword(s):  
Abdominal Wall ◽  
Regional Differences ◽  
Rectus Muscle ◽  
Abdominal Muscle ◽  
Emg Activity ◽  
Abdominal Muscles ◽  
Lower Abdomen ◽  
Supine Posture ◽  
Upper Abdomen ◽  
Real Time Ultrasonography

To determine if regional differences exist in the activity of abdominal muscles during respiratory and nonrespiratory maneuvers, we studied four healthy subjects by comparing electromyographic (EMG) activity from surface electrodes placed lateral to rectus muscle, one pair on the upper abdomen and the other on the lower abdomen. In one subject EMG recordings were made from wires placed in various layers of the abdominal wall. Relative positions and changes in size of anatomic structures during maneuvers were determined from real-time ultrasonography of the abdominal wall. Expulsive or valsalva maneuvers evoked the same relative EMG activity in the upper and lower abdomen. In the resting supine posture no EMG activity was detectable; however, in the standing posture greater tonic EMG activity appeared in the lower abdomen. During rebreathing, phasic EMG activity during expiration was greater in the upper than in the lower abdomen in all subjects. Observations from ultrasonographic and electromyographic evaluations suggest that the control of abdominal muscles and their influence on respiratory mechanics are potentially more complex than has been suggested by previous reports.

Motor responses to positive-pressure breathing in the developing opossum

1985 ◽  
Vol 58 (5) ◽  
pp. 1489-1495 ◽  
Author(s):  
J. P. Farber
Keyword(s):  
Airway Resistance ◽  
Upper Airway ◽  
Abdominal Muscle ◽  
Positive Pressure ◽  
Postnatal Life ◽  
Abdominal Muscles ◽  
Upper Airways ◽  
Motor Responses ◽  
Upper Airway Resistance ◽  
Upper Airway Muscles

The suckling opossum exhibits an expiration-phased discharge in abdominal muscles during positive-pressure breathing (PPB); the response becomes apparent, however, only after the 3rd-5th wk of postnatal life. The purpose of this study was to determine whether the early lack of activation represented a deficiency of segmental outflow to abdominal muscles or whether comparable effects were observed in cranial outflows to muscles of the upper airways due to immaturity of afferent and/or supraspinal pathways. Anesthetized suckling opossums between 15 and 50 days of age were exposed to PPB; electromyogram (EMG) responses in diaphragm and abdominal muscles were measured, along with EMG of larynx dilator muscles and/or upper airway resistance. In animals older than approximately 30 days of age, the onset of PPB was associated with a prolonged expiration-phased EMG activation of larynx dilator muscles and/or decreased upper airway resistance, along with expiratory recruitment of the abdominal muscle EMG. These effects persisted as long as the load was maintained. Younger animals showed only those responses related to the upper airway; in fact, activation of upper airway muscles during PPB could be associated with suppression of the abdominal motor outflow. After unilateral vagotomy, abdominal and upper airway motor responses to PPB were reduced. The balance between PPB-induced excitatory and inhibitory or disfacilitory influences from the supraspinal level on abdominal motoneurons and/or spinal processing of information from higher centers may shift toward net excitation as the opossum matures.

scholarly journals THE THE EFFECT OF ZUMBA EXERCISE FOR INCREASING ABDOMINAL STRENGTH IN WOMEN WHO HAS BEEN GIVING BIRTH AT NORTH SANGLAH VILLAGE

2018 ◽  
Vol 6 (3) ◽  
pp. 9
Author(s):  
I Gusti Ayu Rea Vera Wijaya ◽  
A.A Nyoman Trisna Narta Dewi ◽  
Susy Purnawati
Keyword(s):  
Test Score ◽  
Abdominal Muscle ◽  
Wilcoxon Test ◽  
Abdominal Muscles ◽  
Exclusion Criteria ◽  
Muscle Strengthening ◽  
Group Design ◽  
Strengthening Exercise ◽  
Post Test ◽  
Abdominal Muscle Strength

ABSTRACT               Abdominal muscle strength decreasing could happen in women who has been giving birth. Zumba exercise is a modification of aerobic exercise with latin music and dance that could be used for muscle strengthening exercise. The purpose of the experiment is for knowing the effect of zumba exercise to increase the abdominal muscles strength in women who has been giving birth. The research is a pre-experimental with a pre-test and post-test one group design. The research has been done in North Sanglah Village with total of 18 samples that was chosen by the Curl Up test score and inclusion and exclusion criteria. Data analyzed using Saphiro Wilk test and  Wilcoxon Test. The results shown there are significant increasing of abdominal muscles strength after given the zumba exercise, p=0,000 (p<0,05). Zumba exercise could increase the abdominal muscles strength in samples with a 26,7% increasing percentage.   Keywords: zumba exercise, abdominal mucles strength decreasing.

Triangularis sterni muscle use in supine humans

1987 ◽  
Vol 62 (3) ◽  
pp. 919-925 ◽  
Author(s):  
A. De Troyer ◽  
V. Ninane ◽  
J. J. Gilmartin ◽  
C. Lemerre ◽  
M. Estenne
Keyword(s):  
Normal Subjects ◽  
Abdominal Muscle ◽  
Abdominal Muscles ◽  
Neural Activation ◽  
Trained Subjects ◽  
Rib Cage ◽  
Residual Capacity ◽  
External Oblique ◽  
Head Flexion ◽  
Static Head

The electrical activity of the triangularis sterni (transversus thoracis) muscle was studied in supine humans during resting breathing and a variety of respiratory and nonrespiratory maneuvers known to bring the abdominal muscles into action. Twelve normal subjects, of whom seven were uninformed and untrained, were investigated. The electromyogram of the triangularis sterni was recorded using a concentric needle electrode, and it was compared with the electromyograms of the abdominal (external oblique and rectus abdominis) muscles. The triangularis sterni was usually silent during resting breathing. In contrast, the muscle was invariably activated during expiration from functional residual capacity, expulsive maneuvers, “belly-in” isovolume maneuvers, static head flexion and trunk rotation, and spontaneous events such as speech, coughing, and laughter. When three trained subjects expired voluntarily with considerable recruitment of the triangularis sterni and no abdominal muscle activity, rib cage volume decreased and abdominal volume increased. These results indicate that unlike in the dog, spontaneous quiet expiration in supine humans is essentially a passive process; the human triangularis sterni, however, is a primary muscle of expiration; and its neural activation is largely coupled with that of the abdominals. The triangularis sterni probably contributes to the deflation of the rib cage during active expiration.

Expiratory muscle activity in the awake and sleeping human during lung inflation and hypercapnia

1992 ◽  
Vol 72 (3) ◽  
pp. 881-887 ◽  
Author(s):  
Y. Wakai ◽  
M. M. Welsh ◽  
A. M. Leevers ◽  
J. D. Road
Keyword(s):  
Lung Volume ◽  
Muscle Activity ◽  
Ventilatory Threshold ◽  
Minute Ventilation ◽  
Abdominal Muscle ◽  
Transversus Abdominis ◽  
Abdominal Muscles ◽  
Lung Inflation ◽  
Expiratory Muscle ◽  
Intramuscular Electrodes

Expiratory muscle activity has been shown to occur in awake humans during lung inflation; however, whether this activity is dependent on consciousness is unclear. Therefore we measured abdominal muscle electromyograms (intramuscular electrodes) in 13 subjects studied in the supine position during wakefulness and non-rapid-eye-movement sleep. Lung inflation was produced by nasal continuous positive airway pressure (CPAP). CPAP at 10–15 cmH2O produced phasic expiratory activity in two subjects during wakefulness but produced no activity in any subject during sleep. During sleep, CPAP to 15 cmH2O increased lung volume by 1,260 +/- 215 (SE) ml, but there was no change in minute ventilation. The ventilatory threshold at which phasic abdominal muscle activity was first recorded during hypercapnia was 10.3 +/- 1.1 l/min while awake and 13.8 +/- 1 l/min while asleep (P less than 0.05). Higher lung volumes reduced the threshold for abdominal muscle recruitment during hypercapnia. We conclude that lung inflation alone over the range that we studied does not alter ventilation or produce recruitment of the abdominal muscles in sleeping humans. The internal oblique and transversus abdominis are activated at a lower ventilatory threshold during hypercapnia, and this activation is influenced by state and lung volume.

Respiratory and abdominal muscle responses to expiratory threshold loading in cystic fibrosis

1992 ◽  
Vol 72 (3) ◽  
pp. 842-850 ◽  
Author(s):  
F. Cerny ◽  
L. Armitage ◽  
J. A. Hirsch ◽  
B. Bishop
Keyword(s):  
Cystic Fibrosis ◽  
Tidal Volume ◽  
Body Position ◽  
Minute Ventilation ◽  
Abdominal Muscle ◽  
Abdominal Muscles ◽  
Breathing Frequency ◽  
Control Subjects ◽  
Lung Dysfunction ◽  
Muscle Responses

We hypothesized that the hyperinflation and pulmonary dysfunction of cystic fibrosis (CF) would distort feedback and therefore alter the abdominal muscle response to graded expiratory threshold loads (ETLs). We compared the respiratory and abdominal muscle responses with graded ETLs of seven CF patients with severe lung dysfunction with those of matched healthy control subjects in the supine and 60 degrees head-up positions. Breathing frequency, tidal volume, and ventilatory timing were determined from inspiratory flow recordings. Abdominal electromyograms (EMGs) were detected with surface electrodes placed unilaterally over the external and internal oblique and the rectus abdominis muscles. Thresholds, times of onset, and durations of phasic abdominal activity were determined from raw EMGs; peak amplitudes were determined from integrated EMGs. Graded ETLs were imposed by submerging a tube from the expiratory port of the breathing valve into a column of water at depths of 0–25 cmH2O. We found that breathing frequency, tidal volume, and expired minute ventilation were higher in CF patients than in control subjects during low ETLs; a change in body position did not alter these ventilatory responses in the CF patients but did in the control subjects. All CF patients, but none of the control subjects, had tonic abdominal activity while supine. CF patients recruited abdominal muscles at lower loads, earlier in the respiratory cycle, and to a higher recruitment level in both positions than the control subjects, but burst duration of phasic activity was not different between groups.(ABSTRACT TRUNCATED AT 250 WORDS)

scholarly journals The Association between Body Mass Index and Physical Fitness among Adolescents

2019 ◽  
Vol 4 (1) ◽  
Author(s):  
Muhammad Eka Mardyansyah Simbolon ◽  
Dzihan Khilmi Ayu Firdausi
Keyword(s):  
Body Mass Index ◽  
Physical Fitness ◽  
Body Mass ◽  
Vertical Jump ◽  
Modern Society ◽  
Abdominal Muscle ◽  
Overweight And Obesity ◽  
Abdominal Muscles ◽  
Cardiorespiratory Endurance

The lifestyle and diet of today's modern society can lead to overweight and obesity. Overweight and obesity is now beginning to worry. This study aims to provide a description of the condition of Body Mass Index (BMI) and physical fitness among adolescents in Bangka Belitung Islands in 2017, and how BMI and physical fitness are associated. 105 adolescents were participants of this study, 90 male and 15 female adolescents. Participants aged ± 18 years in the year of the study conducted. Anthropometry is performed to identify participants' BMI. Performance tests were conducted to identify the components of physical fitness related to the health of the participants. Performance of vertical jump (leg power), sprint 60 meter (speed), push-up (strength and endurance of arm muscle), sit-up (strength and endurance of abdominal muscles), and run / walk distance 1000/1200 meters (cardiorespiratory endurance). BMI has a significant correlation with the strength and endurance of arm muscle (t = 3.79, p < 0.05). BMI has a significant correlation with leg power (t = 4.97, p < 0.01). BMI correlates significantly with speed (t = 4.04, p < 0.05). CRE is only significantly correlated with abdominal muscle strength and endurance (t= 2.51, p < 0.01). Overweight and obesity can be prevented through the provision of a program of physical activity that meets the rules of physical fitness. The program should be provided from primary to senior high school and it’s a sustainable long-term program at every level of education at school. Hopefully overweight and obesity can be prevented.

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