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Single-incision laparoscopic repair of Spigelian hernia.

Tran H, Tran K, Zajkowska M, Lam V, Hawthorne WJ - JSLS (2015 Jan-Mar)

Bottom Line: High-lying Spigelian defects were repaired with additional mesh.An additional piece of mesh was used for 3 hernias.There were no clinical recurrences during a mean follow-up period of 6 months (range, 1-15 months).

View Article: PubMed Central - PubMed

Affiliation: Discipline of Surgery, Sydney Medical School, University of Sydney at Westmead Hospital, Westmead, Australia.

ABSTRACT

Introduction: Spigelian hernias represent only 1% to 2% of all abdominal wall hernias. The treatment, however, remains controversial but depends on institutional expertise. This case series reports the first experience with single-incision laparoscopic totally extraperitoneal (SILTEP) repair of Spigelian hernias with telescopic extraperitoneal dissection in combination with inguinal hernia repair.

Methods: From February 2013 to April 2014, all patients referred with inguinal or Spigelian hernias, without histories of extraperitoneal intervention, underwent SILTEP repair with telescopic extraperitoneal dissection. A single-port device, 5.5 mm/52 cm/30° angled laparoscope, and conventional straight dissecting instruments were used for all cases. Extraperitoneal dissection was performed under direct vision with preservation of preperitoneal fascia overlying retroperitoneal nerves. Inguinal herniorrhaphy was performed with lightweight mesh that covered low-lying Spigelian defects. High-lying Spigelian defects were repaired with additional mesh.

Results: There were 131 patients with 186 (92 direct) inguinal hernias and 7 patients with 8 Spigelian hernias (6 incidental, including 1 bilateral and 2 preoperatively diagnosed), with a mean age of 51.3 years and a mean body mass index of 25.1 kg/m(2). An additional piece of mesh was used for 3 hernias. All Spigelian hernias were associated with direct inguinal hernias, and 8 combined inguinal and Spigelian hernias were successfully repaired with SILTEP repair with telescopic extraperitoneal dissection as day cases. There were no clinical recurrences during a mean follow-up period of 6 months (range, 1-15 months).

Conclusions: Combined Spigelian and inguinal hernias can be successfully treated with SILTEP herniorrhaphy with telescopic extraperitoneal dissection. The high incidence of Spigelian hernias associated with direct inguinal hernias suggests a high index of suspicion for Spigelian hernias during laparoscopic inguinal herniorrhaphy.

No MeSH data available.


Related in: MedlinePlus

SIL Spigelian and inguinal hernia repair with telescopic extraperitoneal dissection. (A) A patient with a Spigelian hernia diagnosed and marked by ultrasonography and right inguinal and umbilical hernia diagnosed clinically. (B) Insertion of a blunt rod into the extraperitoneal space. (C) Plastic sheath and introducer of Triport system. (D) The top platform of Triport system. (E) Deployed Triport+. (F) Intraoperative setup for single incision laparoscopic surgery with a 5.5-mm/52-cm/30° angled laparoscope and conventional straight dissecting instruments.
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Figure 1: SIL Spigelian and inguinal hernia repair with telescopic extraperitoneal dissection. (A) A patient with a Spigelian hernia diagnosed and marked by ultrasonography and right inguinal and umbilical hernia diagnosed clinically. (B) Insertion of a blunt rod into the extraperitoneal space. (C) Plastic sheath and introducer of Triport system. (D) The top platform of Triport system. (E) Deployed Triport+. (F) Intraoperative setup for single incision laparoscopic surgery with a 5.5-mm/52-cm/30° angled laparoscope and conventional straight dissecting instruments.

Mentions: After infiltration with 20 mL of bupivacaine 0.5% with 1:200,000 ephedrine, a 1.5-cm crescentic infraumbilical incision was made, and the anterior rectus sheath was incised transversely and the rectus muscle retracted laterally. The patient was then placed in a Trendelenburg position at 15° head down. A blunt rod was inserted into the extraperitoneal space parallel and posterior to the rectus muscle toward the pubic symphysis (Figure 1). This created a small tunnel (similar to placing the distension balloon trocar) to help with the extraperitoneal dissection. The inner ring of the single-port device (Triport+; Olympus Winter & Ibe GmbH, Hamburg, Germany) was then deployed into the extraperitoneal space, and the former was pulled back firmly against the rectus muscle. The excess sheath was then removed before the top platform was placed onto the outer ring. To prevent slippage of the plastic sleeve through the outer ring and the top platform, a wire was tightened around the outer ring (Figure 1). After insufflation with carbon dioxide, a 5.5-mm/30°/52-cm laparoscope (Karl Storz, Tuttlingen, Germany) was placed into the 10-mm port with a 5-mm reducer, and 2 conventional straight dissecting instruments were placed into the 5-mm ports directly into the extraperitoneal space (Figure 1).


Single-incision laparoscopic repair of Spigelian hernia.

Tran H, Tran K, Zajkowska M, Lam V, Hawthorne WJ - JSLS (2015 Jan-Mar)

SIL Spigelian and inguinal hernia repair with telescopic extraperitoneal dissection. (A) A patient with a Spigelian hernia diagnosed and marked by ultrasonography and right inguinal and umbilical hernia diagnosed clinically. (B) Insertion of a blunt rod into the extraperitoneal space. (C) Plastic sheath and introducer of Triport system. (D) The top platform of Triport system. (E) Deployed Triport+. (F) Intraoperative setup for single incision laparoscopic surgery with a 5.5-mm/52-cm/30° angled laparoscope and conventional straight dissecting instruments.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4325554&req=5

Figure 1: SIL Spigelian and inguinal hernia repair with telescopic extraperitoneal dissection. (A) A patient with a Spigelian hernia diagnosed and marked by ultrasonography and right inguinal and umbilical hernia diagnosed clinically. (B) Insertion of a blunt rod into the extraperitoneal space. (C) Plastic sheath and introducer of Triport system. (D) The top platform of Triport system. (E) Deployed Triport+. (F) Intraoperative setup for single incision laparoscopic surgery with a 5.5-mm/52-cm/30° angled laparoscope and conventional straight dissecting instruments.
Mentions: After infiltration with 20 mL of bupivacaine 0.5% with 1:200,000 ephedrine, a 1.5-cm crescentic infraumbilical incision was made, and the anterior rectus sheath was incised transversely and the rectus muscle retracted laterally. The patient was then placed in a Trendelenburg position at 15° head down. A blunt rod was inserted into the extraperitoneal space parallel and posterior to the rectus muscle toward the pubic symphysis (Figure 1). This created a small tunnel (similar to placing the distension balloon trocar) to help with the extraperitoneal dissection. The inner ring of the single-port device (Triport+; Olympus Winter & Ibe GmbH, Hamburg, Germany) was then deployed into the extraperitoneal space, and the former was pulled back firmly against the rectus muscle. The excess sheath was then removed before the top platform was placed onto the outer ring. To prevent slippage of the plastic sleeve through the outer ring and the top platform, a wire was tightened around the outer ring (Figure 1). After insufflation with carbon dioxide, a 5.5-mm/30°/52-cm laparoscope (Karl Storz, Tuttlingen, Germany) was placed into the 10-mm port with a 5-mm reducer, and 2 conventional straight dissecting instruments were placed into the 5-mm ports directly into the extraperitoneal space (Figure 1).

Bottom Line: High-lying Spigelian defects were repaired with additional mesh.An additional piece of mesh was used for 3 hernias.There were no clinical recurrences during a mean follow-up period of 6 months (range, 1-15 months).

View Article: PubMed Central - PubMed

Affiliation: Discipline of Surgery, Sydney Medical School, University of Sydney at Westmead Hospital, Westmead, Australia.

ABSTRACT

Introduction: Spigelian hernias represent only 1% to 2% of all abdominal wall hernias. The treatment, however, remains controversial but depends on institutional expertise. This case series reports the first experience with single-incision laparoscopic totally extraperitoneal (SILTEP) repair of Spigelian hernias with telescopic extraperitoneal dissection in combination with inguinal hernia repair.

Methods: From February 2013 to April 2014, all patients referred with inguinal or Spigelian hernias, without histories of extraperitoneal intervention, underwent SILTEP repair with telescopic extraperitoneal dissection. A single-port device, 5.5 mm/52 cm/30° angled laparoscope, and conventional straight dissecting instruments were used for all cases. Extraperitoneal dissection was performed under direct vision with preservation of preperitoneal fascia overlying retroperitoneal nerves. Inguinal herniorrhaphy was performed with lightweight mesh that covered low-lying Spigelian defects. High-lying Spigelian defects were repaired with additional mesh.

Results: There were 131 patients with 186 (92 direct) inguinal hernias and 7 patients with 8 Spigelian hernias (6 incidental, including 1 bilateral and 2 preoperatively diagnosed), with a mean age of 51.3 years and a mean body mass index of 25.1 kg/m(2). An additional piece of mesh was used for 3 hernias. All Spigelian hernias were associated with direct inguinal hernias, and 8 combined inguinal and Spigelian hernias were successfully repaired with SILTEP repair with telescopic extraperitoneal dissection as day cases. There were no clinical recurrences during a mean follow-up period of 6 months (range, 1-15 months).

Conclusions: Combined Spigelian and inguinal hernias can be successfully treated with SILTEP herniorrhaphy with telescopic extraperitoneal dissection. The high incidence of Spigelian hernias associated with direct inguinal hernias suggests a high index of suspicion for Spigelian hernias during laparoscopic inguinal herniorrhaphy.

No MeSH data available.


Related in: MedlinePlus