spegelian questions

Yes, a small fat containing hernia could be missed on a laparoscopy, If it was that small, it would pose no risk of bowel incarceration (getting stuck in the hernia), but it could cause pain. No, it would not be routine to take down the peritoneum as this is a big undertaking and would only be done if one was anticipating placing a preperitoneal mesh.

For a surgeon, a sliding inguinal hernia specifically refers to part of the hernia sac being the bowel, usually the colon. Sliding hernias are generally fairly large and easy to see on a CT scan or any other study. It is very difficult to differentiate small inguinal hernias from femoral hernias on physical exam and it is possible to confuse them on imaging. It really shouldn’t matter for a laparoscopic repair as it is quite easy to see the entire area at the time of surgery and most repair techniques cover both the inguinal and femoral spaces. All hernias, including spigelian hernias may contain only fat. Smaller hernias will contain preperitoneal fat, which is a layer of fat between the deep fascia (connective tissue) and the peritoneum (the membrane that lines the abdominal cavity). Hernias may also contain omentum, which is a curtain of fat that hangs over the bowel.

A flank bulge can be caused by numerous things including a hernia. A spigelian hernia will be a bulge on the edge of the abdominal muscle (rectus abdominus), usually below the level of the belly button.

A true flank hernia is quite rare unless you have had surgery through the flank, usually to remove a kidney or for vascular surgery. I would not expect a flank hernia to affect the thigh.