Intraoperative Images of the Totally Extraperitoneal Repair of Concurrent Spigelian and Groin Hernias

David B. Staab, MD, John D. Welander, MD

Department of Surgery, Veterans Affairs Central Iowa Health Care System, Des Moines, IA, USA (Dr. Staab). Surgery Residency Program of the Iowa Methodist Medical Center, Des Moines, IA, USA (Dr. Welander).


Minimally invasive surgical technology is changing the management of spigelian hernias. In addition to open repairs, laparoscopic transabdominal repairs as well as laparoscopic totally extraperitoneal repairs are well documented. However, because spigelian hernias are uncommon, few surgeons have a large volume of experience with spigelian hernia repairs. This is particularly true of the repair of spigelian hernias with concurrent inguinal and femoral hernias. We provide intraoperative images of bilateral spigelian and inguinal and femoral hernias repaired via a laparoscopic totally extraperitoneal approach. This patient was successfully treated with a single piece of mesh on each side. The single mesh piece on the right repaired the right spigelian hernia and a femoral hernia. The single mesh piece on the left repaired the spigelian hernia and left direct and indirect inguinal hernias. Preoperative computed tomography scans illustrate the close proximity of the spigelian defects and the inguinal defects that allow the use of a single 10 15-cm mesh piece for repair of each side. Our goal is to provide intraoperative images to allow a surgeon who is experienced with totally extraperitoneal repairs to visualize this operation and apply this approach to other patients with concurrent spigelian and inguinal or femoral hernias.

Key Words: Spigelian hernia, Laparoscopic, Minimally invasive surgery, Totally extraperitoneal repair, Inguinal hernia, Femoral hernia, Mesh repair.

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