Christrian Massier, MD, William T Walsh. South Pointe Hospital
INTRODUCTION: We report a recent case of an emergent repair of an incarcerated Spigelian hernia via laparoscopic transabdominal extraperitoneal (TAP) approach with a polypropylene mesh.
PRESENTATION OF CASE: A 50-year-old female presented to ED with vague abdominal pain and obstructive symptoms. Physical exam was non-specific without peritoneal signs. A contrast enhanced compute tomography was obtained showing left sided incarcerated Spigelian hernia and ventral hernia. On initial induction of pneumoperitoneum, the incarcerated hernia spontaneously reduced and there was an incidental contralateral Spigelian hernia. Patient underwent a left TAP repair and primary repair of right Spigelian and ventral hernia.
DISCUSSION: These hernias are clinically difficult to diagnosis due to their interstitial location. There should be a high index of suspicion for the correct diagnosis to be made via CT scan of the abdomen. There is little literature to state the best approach for repairing these hernias. There have been advocates for open transabdominal, extraperitoneal, and primary closure. The laparoscopic repair is preferred because the outer external oblique remain intact with these hernias and allows for complete inspection of the abdomen for other fascial defects.
CONCLUSION: The use of a TAP repair provides the opportunity to close a Spigelian hernia defect and place a mesh without violating the anterior muscle layer and prevent direct contact between mesh and bowel.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95694
Program Number: P542
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster