Apendicitis aguda dentro de una hernia de Spiegel: un caso infrecuente de una patología infrecuente.

INTRODUCTION: Spigelian hernia is a rare entity, with higher improbability of acute appendicitis within it. CASE REPORT: A 75-year-old female with a 30-year evolution hernia, abdominal pain, and fever of 1 week of onset, in whom was found an acute appendicitis within a Spigelian hernia. DISCUSSION: Spigelian hernia comprises 0.12-2% of all abdominal hernias. Presurgical diagnosis is stablished only in 50% of cases, with an hernial ring less than 2 cm and hidden localization. There isn't statistics of this complication because of the lack of case reports.

INTRODUCCIÓN: La hernia de Spiegel es una afección infrecuente, con una improbabilidad aún mayor de apendicitis aguda en su interior. CASO CLÍNICO: Mujer de 75 años que acude con una hernia de 30 años, dolor abdominal y fiebre de 1 semana de inicio, en quien se encontró apendicitis aguda dentro de una hernia de Spiegel. DISCUSIÓN: La hernia de Spiegel comprende el 0.12-2% de las hernias abdominales. El diagnóstico prequirúrgico se ha logra en el 50% de los casos, con defecto menor de 2 cm y de localización oculta. No existe estadística de esta complicación debido a la escasez de casos reportados.

Hernia de Spiegel: a propósito de un caso / Spiegel Hernia. About a case

Presentamos el caso de una mujer de 86 años con una hernia espigeliana complicada por la oclusión intestinal, cuyo diagnóstico se basó en semiología y tomografía computarizada. En la anamnesis, informó dolor en la fosa ilíaca derecha asociada con los vómitos. El examen físico mostró una masa dura, sensible y móvil ubicada en la fosa ilíaca derecha. La tomografía computarizada abdominal mostró un saco hernial de 13 mm con un cuello en la fosa ilíaca derecha, frente a la aponeurosis del músculo oblicuo externo. Eso contenía grasa y un bucle de intestino delgado. El diagnóstico de hernia espigeliana atascada. La cirugía se realizó con un manejo postoperatorio simple.

We present the case of an 86-year-old woman with a Spigelian hernia complicated by intestinal occlusion, whose diagnosis was based on semiology and computed tomography. In the anamnesis, he reported pain in the right iliac fossa associated with vomiting. Physical examination showed a hard, sensitive, and mobile mass located in the right iliac fossa. abdominal computed tomography showed a 13-mm hernial sac with a neck in the right iliac fossa, in front of the aponeurosis of the external oblique muscle. That contained fat and a loop of small intestine. The diagnosis of stuck Spigelian hernia. The surgery was performed with simple postoperative management

Safety and Efficacy of Laparoscopic Caudate Lobectomy: A Systematic Review.

Resection of the caudate lobe of the liver is considered a highly challenging type of liver resection due to the region's intimacy with critical vascular structures and deep anatomic location inside the abdominal cavity. Laparoscopic resection of the caudate lobe is considered one of the most challenging laparoscopic liver procedures. The objective of our systematic review was to evaluate the safety, technical feasibility and main outcomes of laparoscopic caudate lobectomy LCL. A systematic review of the literature was undertaken for studies published until September 2021. A total of 20 studies comprising 221 patients were included. Of these subjects, 36% were women, whereas the vast majority of resections (66%) were performed for malignant tumors. Tumor size varied significantly between 2 and 160 mm in the largest diameter. The mean operative time was 210 min (range 60-740 min), and estimated blood loss was 173.6 mL (range 50-3600 mL). The median hospital length of stay LOS was 6.5 days (range 2-15 days). Seven cases of conversion to open were reported. The vast majority of patients (93.7%) underwent complete resection (R0) of their tumors. Thirty-six out of 221 patients developed postoperative complications, with 5.8% of all patients developing a major complication (Clavien-Dindo classification ≥ III).No perioperative deaths were reported by the included studies. LCL seems to be a safe and feasible alternative to open caudate lobectomy OCL in selected patients when undertaken in high-volume centers by experienced surgeons.

Hernia semilunar estrangulada. Presentación de caso / Strangulated semilunar hernia. Case report

Una paciente de sexo femenino, obesa, presentó un cuadro de oclusión intestinal secundaria a una hernia de Spiegel estrangulada. Relatamos el proceso diagnóstico, su tratamiento y evolución. Realizamos una revisión bibliográfica de esta poco frecuente presentación, haciendo algunas consideraciones sobre su frecuencia, forma de estudio y posibilidades terapéuticas.

An obese female patient presented with intestinal obstruction secondary to a strangulated Spiegel hernia. We report the diagnostic process, its treatment and evolution. A bibliographical revision is done with considerations on the frequency, diagnostic workup and alternative therapies

Strangulated Spiegel hernia: About a case and literature review.

The anterolateral abdominal Hernias are a frequent reason for consultation; Spiegel's hernia is a rare spontaneous abdominal anterolateral hernia (0.12% of abdominal hernias) for patients between 40 and 70 years old, There are risk factors such as intra-abdominal hyperpressure secondary to morbid obesity, multiple pregnancies and chronic cough. The surgery is the standard treatment; whether by raphy or prosthetic mesch. We report the case of a 42 year old male admitted to the emergency room for an occlusion syndrome due to the strangulated spiegel hernia with caecal and appendicular contents.

Outcome of Orchidopexy in Spigelian Hernia-Undescended Testis Syndrome.

Spigelian hernia-undescended testes (SH-UDT) syndrome is a rare disorder, with only 57 cases reported in the literature. The presentation can be asymptomatic or symptomatic in the form of pain, tenderness, or a lump. We present a case of a 50-day-old boy with SH-UDT syndrome. The patient presented with signs and symptoms of acute intestinal obstruction. Exploration confirmed a Spigelian hernia containing small bowel loops and right undescended testis. Orchidopexy was done after ligation of the hernial sac. A follow-up visit after two years revealed right testicular atrophy.

Hernia de Spiegel y apendicitis aguda necrosada. Un reporte de caso.

BACKGROUND: Spiegel hernia is a rare type of ventral hernia that occurs when there is a defect in the semilunar line (Spiegel line) through which there is protrusion of preperitoneal fat or a peritoneal sac with or without an intra-abdominal viscus. CLINICAL CASE: A 52-year-old female patient admitted for abdominal pain and tumor in the lower right quadrant of 15 cm. In the operating room, wall plasty was performed and when hernia sac was opened, necrotic appendicitis was identified. CONCLUSION: The incidence of hernia is Spiegel is very low and is lower when associated with acute appendicitis. Given its low frequency, clinical suspicion is important. The treatment is surgical.

ANTECEDENTES: La hernia de Spiegel es un tipo de hernia ventral poco frecuente que ocurre cuando existe un defecto en la línea semilunar (línea de Spiegel), a través del cual hay protrusión de grasa preperitoneal o un saco peritoneal con o sin una víscera intraabdominal. CASO CLÍNICO: Mujer de 52 años que ingresa por dolor abdominal y un abultamiento en el cuadrante inferior derecho de 15 centímetros. En quirófano se realiza plastia de pared y al abrir el saco herniario se identifica apendicitis necrosada, por lo que se realiza apendicectomía tipo Pouchet y plastia de pared con malla de polipropileno. CONCLUSIÓN: La incidencia de la hernia se Spiegel es muy baja y lo es aún más cuando se asocia a apendicitis aguda. Dada su baja frecuencia, es importante la sospecha clínica. El tratamiento es quirúrgico.

Hernias poco comunes: hernia de Spiegel. Reporte de caso / Uncommon hernias: Spigelian hernia. Case report

La hernia de Spiegel es un defecto infrecuente de la pared abdominal producido por una alteración en la unión del borde lateral del músculo recto del abdomen y el borde medial del músculo transverso del abdomen en la línea semilunar. Representan apenas del 0,12 al 2% de todas las hernias. La presente investigación se enfocó en describir las manifestaciones clínicas, el diagnóstico, la incidencia, el procedimiento quirúrgico y su evolución en dos casos reportados. Caso 1: Femenina de 33 años, multípara, obesa, quien consulta por dolor y masa palpable en el cuadrante superior izquierdo del abdomen. Al examen físico, se evidenció dolor a la palpación en mesogastrio e hipocondrio izquierdo, exhibiendo protrusión del contenido abdominal, en la línea de Spiegel. Intervención quirúrgica: hernioplastia protésica de Spiegel con colocación de malla supraaponeurótica. Caso 2: Masculino de 89 años, con diagnóstico de EPOC, acudió a consulta presentando dolor abdominal en fosa iliaca y en la región inguino­escrotal izquierda. Al examen físico se evidenció saco herniario en la región inguino­escrotal por lo que se decide su resolución quirúrgica. Como hallazgo transoperatorio se evidenció defecto aponeurótico del recto anterior del abdomen izquierdo en su tercio inferior. Intervención quirúrgica: hernioplastia protésica de Spiegel con colocación de malla supraaponeurótica.Conclusión : La hernia de Spiegel es una entidad poco frecuente por lo que se debe concientizar al cirujano para sospechar este tipo de hernia en aquellos pacientes con presencia de aumento de volumen en la línea de Spiegel(AU)

Spigelian hernia is an infrequent abdominal wall defect caused by an alteration in the joint between lateral edge of the rectus abdominis muscle and the medial egde of the transverse abdominis muscle in the semilunar line. It represent only from 0.12 to 2% of all hernias. This investigation is focussed on describe the clinical manifestations, diagnosis, incidence, the surgical procedure and its evolution in two reported cases. Case 1: A 33 years old female, multiparous, obese, who consulted for pain and palpable mass in the left upper quadrant of the abdomen. Physical examination revealed tenderness between mesogastrium and left hypochondrium, showing protrusion of abdominal content, in the Spigelian line. Surgical intervention: Prosthetic Spiegel hernioplasty with supraaponeurotic mesh. Case 2: An 89 years old male, diagnosed with COPD, attended in the consultation presenting abdominal pain in the iliac fossa and in the left inguino-scrotal region. Physical examination revealed hernial sac in the inguino-scrotal region, reason which its surgical resolution is decided. As an intraoperative finding, an aponeurotic defect of the anterior rectus of the left abdomen was evidenced in its lower third. Surgical intervention: Prosthetic Spiegel hernioplasty with supraaponeurotic mesh.Conclusion : Spigelian hernia is a rare entity, so the surgeon must be focused on suspect this kind of hernia in patients with growth in Spiegel line(AU)

Hernia de Spiegel: diagnóstico dudoso / Spiegel's hernia: doubtful diagnosis / Hérnia de Spiegel: diagnóstico duvidoso

RESUMEN Introducción: la hernia de Spiegel se define como toda protrusión espontánea de grasa preperitoneal, o de un saco peritoneal con contenido visceral, a través de un defecto(anillo) en la aponeurosis o fascia de Spiegel. Objetivo: presentar el siguiente caso pues a pesar de ser conocido, su incidencia es muy baja, por lo que existen problemas para su diagnóstico. Caso clínico: paciente femenina de 72 años de edad con antecedentes de dolor en hemiabdomen inferior izquierdo, intermitente, que aumentó con los esfuerzos. En ocasiones, se palpó un aumento de volumen pequeño en el lado izquierdo del cinturón de Spiegel que protruyó con la maniobra de Valsalva. La ecografia de partes blandas no ayudó al diagnóstico. Durante el transoperatorio se identificó uma hernia de Spiegel. Se reparó con sutura monofilamento no absorbible. Conclusiones: la hernia de Spiegel continúa siendo una afección quirúrgica de difícil diagnóstico clínico.

ABSTRACT Introduction: Spiegel hernia is defined as any spontaneous protrusion of preperitoneal fat, or a peritoneal sac with visceral content, through a defect (ring) in the aponeurosis or Spiegel's fascia. Objective: Present the following case because despite being known, its incidence is very low, so there are problems for its diagnosis. Clinical case: A 72-year-old female patient with a history of lower left hemiabdomen pain, which increased with the efforts. Occasionally, a small volume increase was felt on the left side of the Spiegel belt that protruded with the Valsalva maneuver. Soft tissue ultrasound did not help the diagnosis. During the transoperative period, Spiegel's hernia was identified. It was repaired with non-absorbable monofilament suture. Conclusions: Spiegel's hernia continues to be a surgical condition of difficult clinical diagnosis.

RESUMO Introdução: A hérnia de Spiegel é definida como qualquer protrusão espontânea de gordura pré-peritoneal ou de um saco peritoneal com conteúdo visceral, através de um defeito (anel) na aponeurose ou fáscia de Spiegel. Objetivo: apresentar o caso a seguir, pois apesar de conhecida, sua incidência é muito baixa, havendo problemas para seu diagnóstico. Relato de caso: Paciente do sexo feminino, 72 anos, com história de dor no canto inferior esquerdo, hemiabdomen intermitente à esquerda, que aumentou com o esforço. Ocasionalmente, um pequeno aumento de volume era sentido no lado esquerdo do cinturão de Spiegel que se projetava com a manobra de Valsalva. A ultrassonografia de tecidos moles não ajudou no diagnóstico. Uma hérnia de Spiegel foi identificada durante a operação. Foi reparado com sutura de monofilamento não absorvível. Conclusões: A hérnia de Spiegel continua sendo uma condição cirúrgica com difícil diagnóstico clínico.

Adrianus Spigelius' (1578 - 1625) Ocular Anatomy.

The aim was to study Adriaan van den Spiegel's ideas on ocular anatomy. He is better known by his Latinized name as Adrianus Spigelius (1578 - 1625). He was a Flemish physician and anatomist who lived and worked in Padua, where in 1605 he was elected to be Professor of Anatomy and Surgery. Chapter IX of book ten of Spigelius' work on human anatomy, entitled De humani corporis fabrica libri X tabulis aere icisis exornati (1627) was devoted to an anatomical description of the eye. Corresponding to contemporary ideas of the production of knowledge Spigelius endeavoured to enhance Andreas Vesalius' (1514-1564) anatomy, he did not repeat his predecessor's theories of ocular anatomy. He conceptualised that the eye has six muscles, five tunics and three humors, while he gave a brief description of ocular physiology combining anatomy and the functional role of the anatomic ocular parts. CONCLUSION: He managed to correct Vesalius' errors and to present ocular anatomy with original notes, which so far, have been ignored and are highlighted now.

Hernia de Spiegel: presentación de un caso / Spigelian hernia: case report

RESUMEN Fundamento: La hernia de Spiegel es un defecto de la pared abdominal generalmente mal diagnosticado; en la experiencia de los cirujanos, las hernias de la pared abdominal constituyen una enfermedad cuyo diagnóstico es esencialmente clínico. Sin embargo, la hernia de Spiegel por su infrecuente presentación (0.1 - 2 %) pasa fácilmente inadvertida. Objetivo: Describir el caso de un paciente con una hernia de Spiegel. Presentación del caso: En este artículo presentamos un paciente masculino de 37 años que fue hospitalizado por presentar dolor abdominal de un mes y medio de evolución, al que se le diagnosticó una hernia de Spiegel. Conclusiones: Por las dificultades diagnósticas que presenta esta enfermedad es importante realizar una correcta anamnesis y examen físico, sin dejar de lado estudios de imagen. El tratamiento definitivo de la hernia de Spiegel es el quirúrgico.

ABSTRACT Background: Spigelian hernia is a defect of the abdominal wall that is generally misdiagnosed. In the experience of surgeons, the diagnosis of the abdominal wall hernias is usually clinical. However, because of their presentation is infrequent (0.1 - 2 %) Spigelian hernias often fail to be noticed. Objective: To describe the case of a patient with a Spigelian hernia. Case report: In this article, we present a 37-year-old male patient who was hospitalized due to abdominal pain during a month and a half of evolution, who was diagnosed with a Spigelian hernia. Conclusions: Due to the diagnostic difficulties this disease presents it is important to accomplish a correct anamnesis and physical examination, without putting aside studies of image. The definite treatment of Spigelian hernia is surgery.

Hernia de Spiegel: presentación de un caso / Spigelian hernia: case report

RESUMEN Fundamento: La hernia de Spiegel es un defecto de la pared abdominal generalmente mal diagnosticado; en la experiencia de los cirujanos, las hernias de la pared abdominal constituyen una enfermedad cuyo diagnóstico es esencialmente clínico. Sin embargo, la hernia de Spiegel por su infrecuente presentación (0.1 - 2 %) pasa fácilmente inadvertida. Objetivo: Describir el caso de un paciente con una hernia de Spiegel. Presentación del caso: En este artículo presentamos un paciente masculino de 37 años que fue hospitalizado por presentar dolor abdominal de un mes y medio de evolución, al que se le diagnosticó una hernia de Spiegel. Conclusiones: Por las dificultades diagnósticas que presenta esta enfermedad es importante realizar una correcta anamnesis y examen físico, sin dejar de lado estudios de imagen. El tratamiento definitivo de la hernia de Spiegel es el quirúrgico.

ABSTRACT Background: Spigelian hernia is a defect of the abdominal wall that is generally misdiagnosed. In the experience of surgeons, the diagnosis of the abdominal wall hernias is usually clinical. However, because of their presentation is infrequent (0.1 - 2 %) Spigelian hernias often fail to be noticed. Objective: To describe the case of a patient with a Spigelian hernia. Case report: In this article, we present a 37-year-old male patient who was hospitalized due to abdominal pain during a month and a half of evolution, who was diagnosed with a Spigelian hernia. Conclusions: Due to the diagnostic difficulties this disease presents it is important to accomplish a correct anamnesis and physical examination, without putting aside studies of image. The definite treatment of Spigelian hernia is surgery.

Hernia de Spiegel. A propósito de un caso / Spiegelian hernia. A propos of a case

RESUMEN La hernia de Spiegel es un defecto raro de la pared abdominal. Su diagnóstico se hace muy difícil por lo infrecuente y por la dificultad para diferenciarla de la hernia inguinal supravesical. Precisamente, por lo poco común, los médicos muchas veces no valoran seriamente la presencia de esta variedad de hernia. Constituye una patología en la que el diagnóstico al igual que el resto de las hernias de la pared abdominal, es esencialmente clínico. El objetivo de este trabajo es informar un caso con un tipo de hernia poco común. Paciente de 50 años de edad, de color de piel blanca, obesa, multípara de procedencia urbana, con antecedentes personales patológico de relativa buena salud. Acudió a consulta por presentar dolor en la región inferior derecha, en la unión del flanco derecho con el mesogastrio, desde hacía varios meses. Fue diagnosticada con una hernia de Spiegel. Se le realizaron los estudios correspondientes fue intervenida quirúrgicamente realizándose hernioplastia (AU).

ABSTRACT Spiegelian hernia is a rare defect of the abdominal wall. Its diagnosis is very difficult because of its infrequency and the difficult of differentiating it from the supravesical inguinal hernia. Precisely due to its infrequence the doctors usually do not seriously evaluate the presence of this kind of hernia. It is a pathology in which, like in the rest of the abdominal wall hernias, the diagnosis is essentially clinical. The aim of this work is to report a case of a patient with an uncommon kind of hernia: a female, obese, multiparous, white patient, aged 50 years, from urban precedence, with personal pathological antecedents of relatively good health, assisted the consultation presenting pain in the right inferior region, in the place where the right flank meets the mesogastrium for several months. She was diagnosed a Spiegel's hernia. The correspondent studies were carried out and she underwent a hernioplasty (AU).

Hernia de Spiegel. A propósito de un caso / Spiegelian hernia. A propos of a case

RESUMEN La hernia de Spiegel es un defecto raro de la pared abdominal. Su diagnóstico se hace muy difícil por lo infrecuente y por la dificultad para diferenciarla de la hernia inguinal supravesical. Precisamente, por lo poco común, los médicos muchas veces no valoran seriamente la presencia de esta variedad de hernia. Constituye una patología en la que el diagnóstico al igual que el resto de las hernias de la pared abdominal, es esencialmente clínico. El objetivo de este trabajo es informar un caso con un tipo de hernia poco común. Paciente de 50 años de edad, de color de piel blanca, obesa, multípara de procedencia urbana, con antecedentes personales patológico de relativa buena salud. Acudió a consulta por presentar dolor en la región inferior derecha, en la unión del flanco derecho con el mesogastrio, desde hacía varios meses. Fue diagnosticada con una hernia de Spiegel. Se le realizaron los estudios correspondientes fue intervenida quirúrgicamente realizándose hernioplastia.

ABSTRACT Spiegelian hernia is a rare defect of the abdominal wall. Its diagnosis is very difficult because of its infrequency and the difficult of differentiating it from the supravesical inguinal hernia. Precisely due to its infrequence the doctors usually do not seriously evaluate the presence of this kind of hernia. It is a pathology in which, like in the rest of the abdominal wall hernias, the diagnosis is essentially clinical. The aim of this work is to report a case of a patient with an uncommon kind of hernia: a female, obese, multiparous, white patient, aged 50 years, from urban precedence, with personal pathological antecedents of relatively good health, assisted the consultation presenting pain in the right inferior region, in the place where the right flank meets the mesogastrium for several months. She was diagnosed a Spiegel's hernia. The correspondent studies were carried out and she underwent a hernioplasty.

Laparoscopic Spigelian hernia repair with intraperitoneal onlay composite mesh and articulated fixing system. Two cases report.

INTRODUCTION: Spiegel hernia is an infrequent type of abdominal wall defect. Traditionally, it was repaired with an open technique, currently we have multiple laparoscopic techniques with the use of prosthetic material. CLINICAL CASE: We present two cases of Spiegel hernia, one patient scheduled electively and one patient of urgency due to incarcerated hernia, both diagnosed pre-surgically with abdominal tomography. DISCUSSION: Both patients were successfully operated laparoscopically with intraperitoneal onlay mesh technique using composite mesh and articulated fixation system. CONCLUSION: This technique is shown as a recommended option due to its technical facility, good results, both for elective surgeries and emergency surgeries.

INTRODUCCIÓN: La hernia de Spiegel es un tipo infrecuente de defecto de la pared abdominal. Tradicionalmente se realizaba su reparación con técnica abierta, pero en la actualidad contamos con múltiples técnicas laparoscópicas con uso de material protésico. CASO CLÍNICO: Presentamos dos casos de hernia de Spiegel, un paciente programado de manera electiva y otro de urgencia por hernia incarcerada, ambos diagnosticados de manera prequirúrgica con tomografía abdominal. DISCUSIÓN: Los dos pacientes fueron intervenidos de manera exitosa por vía laparoscópica con técnica de malla intraperitoneal utilizando malla compuesta y sistema de fijación articulado. CONCLUSIONES: Esta técnica se muestra como una opción recomendable por su facilidad de realización y buenos resultados, tanto para cirugías electivas como para cirugías de urgencia.

[Abordaje laparoscópico de una hernia de Spiegel en edad pediátrica. Revisión de la literatura]. / Laparoscopic Spigelian hernia repair in childhood. Literature review.

BACKGROUND: Spigelian hernia is a ventral hernia in the anterior abdominal wall extremely rare in children. CLINIC CASE: A 13 years old patient is presented with a Spigelian hernia. A surgical repair was successfully performed through a laparoscopic transperitoneal approach without prosthetic reinforcement. A review of 35 pediatric patients published on PubMed between 2000 and 2015 was performed and different therapeutic approaches in pediatric patients were analyzed. Only one patient, and the case reported on this paper, was entirely treated with a laparoscopic approach. CONCLUSIONS: Spigelian hernias in childhood can be securely closured with laparoscopic transperitoneal approach.

ANTECEDENTES: La hernia de Spiegel es una hernia ventral de la pared abdominal infrecuente en niños. CASO CLÍNICO: Se presenta el caso de un paciente de 13 años con una hernia de Spiegel que se reparó mediante abordaje laparoscópico transperitoneal con éxito sin refuerzo protésico. Se realizó una revisión de 35 casos en edad pediátrica publicados en PubMed entre los años 2000 y 2015, y se analizaron los diferentes abordajes terapéuticos. Solo un paciente, además del presentado en este trabajo, fue tratado íntegramente mediante abordaje laparoscópico. CONCLUSIONES: Las hernias de Spiegel en edad pediátrica podrían tratarse quirúrgicamente con seguridad mediante una herniorrafia laparoscópica transabdominal.

Standardization of surgical procedures for laparoscopic Spiegel lobectomy: A single-institutional experience.

INTRODUCTION: Surgical techniques for Spiegel lobectomy remain technically difficult because of its deep anatomical location. Laparoscopic Spiegel lobectomy has not yet been standardized or widely reported. In the current study, we introduce technical improvements, including the liver hanging maneuver, to laparoscopic Spiegel lobectomy. Additionally, we demonstrate the safety and feasibility of this procedure. MATERIALS AND SURGICAL TECHNIQUE: We performed consecutive laparoscopic Spiegel lobectomy on six patients: five with hepatocellular carcinoma and one with colorectal liver metastasis. As preparation before liver parenchymal resection, necessary and sufficient mobilization of the Spiegel lobe was performed. A few Glissonian pedicles of the Spiegel lobe were exposed from the hilar plate and divided to reduce the inflow to the Spiegel lobe. After that, vessel tape was used in the hanging maneuver. The tape was pulled forward to give the cutting plane moderate tension during liver parenchymal resection. Lifting this tape provided better exposure for determining the correct cutting plane during liver parenchymal transection. The median operation time was 207 min (range, 147-240 min) and the median intraoperative blood loss was 35 mL (range, 15-85 mL). There were no severe postoperative complications. DISCUSSION: We safely performed laparoscopic Spiegel lobectomy. To maintain a sufficient surgical view, especially during liver parenchymal resection, the hanging maneuver may be a useful technique. This single-center investigation into standardized laparoscopic Spiegel lobectomy featuring improvements in technique showed potential for favorable results.

Surgical treatment for the excluded bile leakage from Spiegel lobe after right hemihepatectomy: A case report.

INRODUCTION: The treatments of excluded bile duct leakage after hepatectomy are not easy and various strategies have been reported, such as surgery, ethanol or fibrin glue injection, and portal vein embolization. PRESENTATION OF CASE: A 72-year-old man with a surgical history of laparoscopic ileocecal resection for diverticular bleeding was diagnosed as having hepatocellular carcinoma. Right hemihepatectomy was performed, and computed tomography examination on postoperative day 9 showed abdominal fluid collection in the right subphrenic space. Percutaneous intra-abdominal fluid drainage was performed and it was diagnosed as bile leakage. After that it was diagnosed as excluded bile leakage from the Spiegel lobe by drip infusion cholangiographic-computed tomography and endoscopic retrograde cholangiography. To improve this clinical condition, we performed the Spiegel lobe excision on postoperative day 48. The postoperative course was uneventful and the patient was discharged. DISCUSSION: According to the postoperative examination, it appeared that the bile duct from the Spiegel lobe joined to the right main bile duct or the bile duct of the right posterior section. This bile duct anomaly was not detected preoperatively on imaging examination. It is most likely that the bile duct from the Spiegel lobe was cut when the hepatoduodenal ligament in the hepatic hilum was peeled. To prevent excluded bile leakage, the hepatoduodenal ligament should be carefully peeled and ligated instead of using energy devices. CONCLUSION: We consider that surgical treatment for postoperative excluded bile leakage is both a quick and reliable procedure in patients with acceptable liver function and anatomical subject.