Total extraperitoneal (TEP) repair of spigelian hernia

Abstract

Aim: Spigelian hernia is a rare lateral ventral hernia traditionally repaired through open incision. Three laparoscopic techniques were reported in the literature: intraperitoneal onlay mesh (IPOM), transabdominal preperitoneal (TAPP) and total extraperitoneal (TEP). TEP is a less practiced approach worldwide. We present TEP repair of a left Spigelian hernia in a 64-year-old lady. Methods: After the induction of general anaesthesia, the urinary bladder was catheterized. The patient was placed in a supine position with both arms adducted. A three-port technique with open cut-down through an ipsilateral infra-umbilical incision and two midline working ports was adopted. The preperitoneal space was created by telescopic dissection at the midline. We used sharp dissection initially and identified the pubic bone and the inferior epigastric vessels. The Spigelian hernia sac was identified and reduced. After parietalization of the round ligament by 4 cm, a lightweight polyester mesh was inserted to cover both the Spigelian defect and the myopectineal orifice. The mesh was fixed with cyanoacrylate glue. Finally, the preperitoneal space was deflated under direct vision. Results: The operative duration was 43 minutes. There was no conversion to open or intraoperative complication. The patient was discharged on postoperative day 1. There was no recurrence or chronic pain at follow-up after 9 months. Conclusions: We find the TEP approach safe and effective for Spigelian hernia repair.