Totally Extraperitoneal Repair of a Spigelian Hernia

TOTALLYEXTRAPERITONEALREPAIROFASPIGELIANHERNIA

Allocco, Frances MD; Reardon, Patrick MD; Saad, Mohamed MD; Dunkin, Brian MD

Spigelian hernias are rare and account for up to 2% of abdominal wall hernias. In the past these were repaired using an open technique, but over the past two decades, there have been a growing number of reports of laparoscopic repairs. Over the past decade we have seen these reports to include totally extraperitoneal repairs.

Here we present a video of a totally extraperitoneal repair of a Spigelian hernia and briefly review Spigelian hernias and their laparoscopic repair, based on review of the literature.

The patient is a 65 year old female with a bulge in the right lower quadrant of her abdomen. She noted the bulge a year previous but did not seek medical attention at that time. Over the course of six months, she began experiencing occasional pain in the area which was becoming more frequent, and presented to us.

Our plan was to perform a totally extraperitoneal repair of this hernia. At the beginning of the procedure we placed a 2mm trocar and insufflated the peritoneal cavity, and confirmed the hernia to be a Spigelian hernia. We then repaired the hernia using a totally extraperitoneal approach, using a 2mm and a 5mm port. After reducing the hernia sac we measured the defect to be 1.2 x 4 cm. Our dissection allowed for a 6 x 6 inch piece of mesh to be tacked in place. At the end of the procedure we re-insufflated the peritoneal cavity and saw our mesh lying completely flat.

The patient went home the same day and was seen in follow-up with an intact repair and no further complaints.

Spigelian hernias usually present in patients 40 to 80 years old. Physical exam correctly identifies approximately 50%, as many are interparietal hernias, and so do not present with a bulge. Most are 1 to 2 centimeters with a risk of incarceration as high as 24.1% and a strangulation risk of 2.4-14%. Recurrence is low for open and laparoscopic repair. Currently there is one prospective randomized controlled trial of open versus laparoscopic elective Spigelian hernia repair by Moreno-Egea et al in 2002. It showed decrease in morbidity and hospital stay and concluded TEP repair to offer the best results.

Here we show how a Spigelian hernia can be laparoscopically diagnosed and treated with a totally extraperitoneal approach, using 2 and 5 mm ports, in a manner similar to an inguinal hernia repair.


Session: Podium Video Presentation

Program Number: V022

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