Laparoscopic pre-peritoneal mesh approach in Spigelian herniorrhaphy. A case report

We present a unique case of a Spigelian hernia and its laparoscopic pre-peritoneal mesh herniorrhaphy. A Spigelian hernia is the only known interparietal hernia of the abdominal wall and its clinical diagnosis and management remain elusive. Various attempts at surgical repair have included open, laparoscopic and robotic techniques. The mesh placement has varied between an on lay, underlay, or pre-peritoneal fixation. Current hernia guidelines remain nebulous as to the correct technique and mesh placement. Our case remains unique because the peritoneum was quite emaciated and could not be used for a proper mesh reperitonealization. We, therefore, used the hernia sac to cover our non-absorbable nylon mesh. We believe this adds to the rarity of this case report. The patient`s recovery was uneventful. She has no hernia recurrence at six months post-surgical herniorrhaphy. A surgical follow-up of at least five years is required to determine the feasibility of our technique.