125 views
Lateral abdominal wall hernias refer to structural weaknesses in the muscles and fascia along the side of the abdomen. These defects are relatively rare and can be challenging to diagnose due to their location and often subtle presentation. Patients may experience localized pain or discomfort.
The aim of this presentation is to describe a case of a patient with a lateral Spigelian hernia and to demonstrate a minimally invasive technique for its correction.
1. Patient Positioning and Preparation
2. Trocar Placement
3. Diagnostic Laparoscopy
4. Identification of the Hernia Defect
5. Peritoneal Incision
6. Dissection of Preperitoneal Space
7. Hernia Reduction and Sac Management
8. Mesh Placement
9. Fixation of the Mesh
10. Closure of Peritoneum
Abdominal Hernia
1. Inability to Tolerate General Anesthesia
2. Incarcerated or Strangulated Hernia with Bowel Ischemia
3. Peritonitis or Active Intra-Abdominal Infection
4. Massive Intra-Abdominal Adhesions (from Previous Surgeries)
The surgeon was positioned on the patient’s left side, with the first assistant on the surgeon’s left side. The surgery started with the placement of a 12 mm trocar with direct optical entry at the left para-umbilical region to accommodate a 30-degree camera. One more 12 mm trocar was placed at a slightly lower level in line with the first trocar and a third trocar of 5 mm was placed at the epigastric region completing the triangulation. The upper and lower ports were used as working ports by the surgeon.
The CT scan is essential for surgery planning
1. Semilunar line
2. Arcuate line
3. Inferior Epigastric Vessels
4. Rectus Abdominis Muscle
5. Transversalis Fascia
Advantages of TAPP for Spigelian Hernia:
- Offers a clear view of the anatomy and the defect.
- Provides a tension-free repair with mesh, reducing the risk of recurrence.
- Minimally invasive, leading to less postoperative pain and faster recovery.
Disadvantages:
- More Technically Demanding: The TAPP approach requires advanced laparoscopic skills, especially when handling delicate structures, suturing the peritoneum, or working in a confined space.
- Longer Surgery Duration
1. Intra-Abdominal Access
2 . Potential for Organ Injury
3. Adhesion Formation
4. Bowel Obstruction
None
Drª. Zara Caetano
Muysoms FE, Miserez M, Berrevoet F, et al. Classification of primary and incisional abdominal wall hernias. Hernia. 2009;13(4):407-414. doi:10.1007/s10029-009-0518-x
Review Laparoscopic TAPP repair of a Spigelian Hernia.