Laparoscopic repair of incidentally found Spigelian hernia

Abstract

Background and objectives: A Spigelian hernia is a rare type of hernia that occurs through a defect in the anterior abdominal wall adjacent to the linea semilunaris. Estimation of its incidence has been reported as 0.12% of all abdominal wall hernias. Traditionally, the method of repair has been an open approach. Herein, we discuss a series of laparoscopic repairs.

Methods: Case series and review of the literature.

Cases: Three patients are presented. All were evaluated and taken to surgery initially for a different disease process, and all were incidentally found to have a spigelian hernia. These patients underwent laparoscopic repair of their hernias; 2 were repaired intraperitoneally and one was repaired totally extraperitoneally. Two patients initially underwent a mesh repair, while the third had an attempted primary repair.

Conclusions: There is evidence that supports the use of laparoscopy for both diagnosis and repair of spigelian hernias. There are also reports of successful repairs both primarily and with mesh. In our experience with the preceding 3 patients, we found that laparoscopic repair of incidentally discovered spigelian hernias is a viable option, and we also found that implantation of mesh, when possible, resulted in satisfactory results and no recurrence.

Figure 1.

CT Scan image revealing right sided Spigelian hernia.

Figure 2.

Laparoscopic view of Spigelian hernia defect.

Figure 3.

Laparoscopic view depicting Spigelian hernia and reduced bowel.

Figure 4.

Laparoscopic view showing contused but viable small bowel, reduced from Spigelian hernia.