Spigelian Hernia Repaired by Laparoscopic Surgery with Composite Mesh

Abstract

We performed laparoscopic tension-free surgery for a case of spigelian hernia (SH) using composite mesh. A 88-year-old woman was referred to our hospital for evaluation of a painful palpable mass over her right lower abdomen. Abdominal ultrasonography and CT revealed a loop of the small intestine at the lateral edge of rectus abdominal muscle, and the hernial orifice was about 2 cm in diameter. This case was diagnosed as SH preoperatively, and laparoscopic repair of the hernia was performed. The hernial defect was located in the spigelian aponeurosis outside of the right rectus abdominal muscle, and this case was definitively diagnosed as SH under direct visual observation. Composite mesh was used to cover the hernia defect, and the edge of the mesh was fixed to the abdominal wall with 22 tacks. Laparoscopic surgery using composite mesh is suitable for SH, especially in aged patients, and it allows intraoperative diagnosis, less invasive surgery, and less mesh-related complications.