CPT® Code 49590

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A spigelian hernia repair involves the surgical correction of a specific type of hernia known as a spigelian hernia, which is characterized by the protrusion of abdominal contents through the semilunar line. This line is located at the lateral border of the rectus sheath, extending from the tip of the ninth rib to the pubic tubercle. Spigelian hernias, also referred to as lateral ventral hernias, typically occur in the lower abdomen, where they can pass through the conjoined tendon formed by the transversus abdominis and internal oblique muscles. The surgical procedure begins with a skin incision made directly over the hernia defect. If the hernia sac is located within the subcutaneous tissue, it will be immediately visible upon incision. In cases where the hernia sac is interstitial, the incision may need to be extended into the external oblique muscle to adequately access the sac. The surgeon then carefully dissects the hernia sac from the surrounding tissue down to its neck, ensuring that the contents of the sac are inspected. If the bowel appears healthy, it is returned to the abdominal cavity. Any adhesions that may be present are severed, and the hernia sac is either excised or inverted. Finally, the defects in the fascia of the transversus abdominis and internal oblique muscles are closed, followed by the closure of the external oblique muscle incision. This procedure is essential for preventing complications associated with hernias, such as incarceration or strangulation of the bowel.