Authors’ reply: Giant spigelian hernia due to abdominal wall injury: a case report [Hernia (2006) 11:67–69

Abstract

To the Editors, We thank LosanoV and Basson for their critique of our case report. First of all, we wish to emphasize that our paper was not a review article; it was only a case report. The size that a Spigelian hernia (SH) needs to be before it can be termed “giant” is yet to be deWned in the English literature. Furthermore, a 10-cm-diameter muscular defect is very large for this kind of hernia. We presented only the diameter of the hernia neck, because it was a stable measurement; the clinical size of the hernia was actually much more than this. The authors doubt whether our case was a SH. Our patient did not show any history of SH before the trauma. Some post-traumatic SHs like ours have been reported in the literature previously, however [1, 2]. We agree with the authors’ skepticism regarding whether this kind of hernia should be called a SH or post-traumatic hernia. Abdominal trauma can suddenly increase the intraabdominal pressure and cause SH [3]. The term “Spigelian hernia” does not just refer to a type of hernia; the term also describes the location of the hernia. Therefore, it is diYcult to state that such a hernia that presents after trauma is not a SH. We used nonabsorbable multiWlament mesh in this case. The infection rate in abdominal wall reconstruction with mesh, for clean surgeries, is 1–2% of all grafts. Engelsman et al. [4] stated that multiWlament meshes have a higher infection rate in their review article. However, there was no reference that included a clinical study of this issue in their article. We think that bacterial contamination during surgery is the main factor in this rate. In one randomized clinical study, the recurrence rates for diVerent types of meshes used in hernia repair were not found to be signiWcantly diVerent [5]. Again, there is no published randomized controlled clinical trial in the English literature that reports that sublay or intermuscular mesh placement is better than onlay placement. We agree with LosanoV and Basson that laparoscopic SH repair is an alternative to the open technique. The open technique was our patient’s preference. Furthermore, laparoscopic hernia repair is more expensive than the open technique in our country. On the other hand, the recurrence rate is lower when the open technique is used in inguinal hernia repair rather than the laparoscopic technique, according to a study published recently [6].