Minimally invasive spigelian hernia repair

Abstract

Introduction: Spigelian hernia is an uncommon ventral hernia characterized by a defect in the linea semilunaris. Repair of spigelian hernia has traditionally been accomplished via an open transverse incision and primary repair. The purpose of this article is to present 2 case reports of incarcerated spigelian hernia that were successfully repaired laparoscopically using Gortex mesh and to present a review of the literature regarding laparoscopic repair of spigelian hernias.

Methods: Retrospective chart review and Medline literature search.

Results: Two patients underwent laparoscopic mesh repair of incarcerated spigelian hernias. Both were started on a regular diet on postoperative day 1 and discharged on postoperative days 2 and 3. One patient developed a seroma that resolved without intervention. There was complete resolution of preoperative symptoms at the 12-month follow-up.

Conclusion: Minimally invasive repair of spigelian hernias is an alternative to the traditional open surgical technique. Further studies are needed to directly compare the open and the laparoscopic repair.

Figure 1.

Abdominal computed tomography of a right-sided incarcerated spigelian hernia. White arrow depicts the right-sided hernia sac that has protruded through the transverses abdominus, internal oblique, and external oblique muscles.

Figure 2.

Intraoperative image of the right-sided incarcerated spigelian hernia. The hernia sac contained omentum and bowel.

Figure 3.

Intraabdominal photograph depicting the dual-sided Gortex mesh with all 4 Gortex stay sutures.

Figure 4.

Intraabdominal photograph depicting the dual-sided Gortex mesh flush against the anterior abdominal wall with the metallic spiral tacks.