Mayank Roy, MD, MRCS, Vickna Balarajah, MD, MRCS, Satvinder Mudan, MD, FRCS. The London Clinic
Introduction: Spigelian hernias (SH) are rare and the anatomical landmarks can be challenging to identify at the operation.We describe a rare case of bilateral SH managed by laparoscopic transabdominal preperitoneal repair.
Methods: A 69-year-old Caucasian male presented with bilateral lower abdominal bulge and pain with increasing severity for six months. The bulge was exaggerated due to recent intentional weight loss as per the patient. Bilateral SH was confirmed on ultrasound. Appropriate consent was taken to repair the bilateral SH. Intraperitoneal access was gained through a 12-mm Optiview trocar in the left lower quadrant. A 12-mm port in the epigastric area and three 5-mm trocars were placed in the outer quadrant for proper triangulation. SH boundary was identified by anatomical landmarks (lateral edge of rectus abdominis, inferior to the arcuate line). Other important landmarks including the inferior epigastric vessels, vas deferens, the triangle of doom and triangle pain were identified. SH site was closed using an endoclose device followed by placement of a 15×15 proceed mesh to cover the SH site as well as the inguinal hernia. A similar repair was performed on the opposite side. Total operative time was seventy-five minutes.
Results: Patient was discharged on postoperative day 1. The patient was asymptomatic at four weeks follow up.
Conclusion: Laparoscopic transabdominal preperitoneal repair of bilateral SH can be performed with low morbidity. A laparoscopic approach can help in the identification of anatomical landmarks of SH, and the inguinal hernia sites can be covered by a mesh simultaneously.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93663
Program Number: V284
Presentation Session: Video Loop Day 2
Presentation Type: VideoLoop