V-015 ENDOSCOPIC MANAGEMENT OF AN INCARCERATED SPIGELIAN HERNIA

Abstract

Abstract Introduction Spigelian hernias are abdominal wall hernias (incidence 0.12% to 2%). It is more common in women over the age of 60 years and occurs in individuals with raised intraabdominal pressure or weakening of the abdominal fascial layers. Several studies suggest that about 27% of Spigelian hernia will incarcerate and this will require immediate surgical intervention depending on the presentation. Presentation A 76-year-old lady presented with a painful lump at the right lower abdomen since a few days. No other constitutional symptoms were reported. She denied any comorbidities and was on no medication that would contraindicate a general anaesthetic. On Examination she had a 2cm tender non reducible lump at the right Spigelian line. A CT scan revealed a break in the right side of the abdominal wall consistent with a Spigelian Hernia. She underwent a repair using a laparoscopic, totally extraperitoneal technique (TEP). This was undertaken as a day case surgery with the hernia containing extraperitoneal fat only. The video demonstrates surgery with balloon dissection, medial to lateral dissection displaying the ilio-pectineal (cooper's) ligament and reduction of the hernia. The defect was covered with a mesh and fixated with Tisseel fibrin sealant. On her 4th week outpatient follow up she recovered well with only a small seroma at the previous site of the Spigelian hernia. Conclusion Our video demonstrates an efficient way to perform a Laparoscopic totally extraperitoneal (TEP) technique for an incarcerated Spigelian Hernia.