V-023 ETEP REPAIR OF AN M2-3 W2 INCISIONAL HERNIA WITH AN ASSOCIATED SPIEGEL HERNIA. A CASE REPORT

Abstract

Abstract Aim To describe a case of an extended-view totally extraperitoneal approach for both an M2-3 W2 incisional hernia with an associated right Spiegel hernia. Material & Methods A 68a female with a previous medical history of a midline laparotomy after diffuse peritonitis presented with a midline bulge in the upper third of the previous surgical wound. Preoperative CT scan showed a midline hernia of 4cm and found a right-sided Spiegel hernia of 3cm. Endoscopic treatment of both defects was offered and accepted. Results Patient was placed in supine position. Retromuscular space was created using blunt dissection with a balloon, which helped with direct visualization. Two 5mm trocars were placed in the left pararectal region. Dissection was performed and crossover from left to right was achieved following standard eTEP procedure. Reduction of preperitoneal fat was performed, and midline defects identified. Dissection was continued to the Retzius space and Cooper's ligaments. Identification and reduction of the Spiegel hernia followed. After completing the dissection of the retro rectus and preperitoneal space, primary closure was performed. A lightweight polypropylene mesh was deployed. No complications ocurred and discharge was on the 2nd day. Conclusions Treatment of incisional hernias is in evolution, as minimally invasive techniques have developed greatly since their description and now have a more widespread use among surgeons. eTEP is a novel approach that can be used for the treatment of midline incisional and some primary hernias, as shown in the case, with satisfactory short-term results and similar long-term outcomes to other techniques.