Khoo Teck Puat Hospital1
Spigelian hernia with concurrent inguinal hernia is rare. The hernia location makes laparoscopic repair difficult, and this is commonly repaired by the open method. We present the technical considerations and feasibility of laparoscopic repair for a Spigelian-inguinal complex hernia and a patient who underwent laparoscopic hernia repair.
The two authors independently searched MEDLINE, Embase, Cochrane databases from inception to July 2021 for concurrent Spigelian and inguinal hernias reports. Studies of laparoscopic repairs were included.
10 case reports and 1 case series were reviewed. These studies included 15 patients, of which 11 patients underwent laparoscopic transabdominal preperitoneal (TAPP) repair, and 4 patients underwent laparoscopic totally extraperitoneal (TEP) repair. 1 patient developed a seroma post-operatively that was managed conservatively.
We performed laparoscopic hernia repair for a 59-year-old female who presented with symptomatic irreducible left lower abdominal and groin hernia. Computed tomography revealed a large Spigelian-inguinal complex hernia, with a hernia neck of 3.1 cm. The laparoscopic transabdominal preperitoneal repair was performed. The hernia was reduced intraoperatively, preperitoneal space dissected, Spigelian defect sutured close, and a 10 x 15 cm macroporous polypropylene mesh covering both hernias orifices was placed in the preperitoneal plane, tacked to Cooper’s ligament and anterior abdominal wall. The patient was discharged the next day and recovered well.
The Intraperitoneal Onlay Mesh (IPOM) repair technique by placing a large composite mesh and securing the mesh with double crown technique is not feasible due to the location of concurrent Spigelian inguinal hernias. However, TAPP and TEP repairs are feasible.