BILATERAL SPIGELIAN HERNIA: RARE HERNIA, EVEN RARER PRESENTATION. adolfo.fuentes2001@gmail.com

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BILATERAL SPIGELIAN HERNIA: RARE HERNIA, EVEN RARER PRESENTATION.

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Mexico

Video

Spigelian hernia is a rare ventral abdominal wall defect, representing just 1-2% of all ventral hernias. Bilateral presentation is extremely rare, accounting for 6.25% of Spigelian hernia cases. Some series report a female predominance (2:1), though some report that the distribution of cases are balanced. Clinical presentation is often nonspecific, with localized pain and/or a lateral abdominal bulge. Imaging tests are essential for its diagnosis, CT being the confirmatory diagnostic test. Surgical repair is recommended due to the risk of complications.

A 67-year-old woman evaluated for 5 month bilateral flank pain with intermittent swelling on both sides. Physical examination revealed bilateral reducible hernia defects without incarceration. Ultrasound and CT confirmed a bilateral spigelian hernia defect, measuring up to 2.1cm on the right side and 1.3cm on the left. A laparoscopic transabdominal preperitoneal (TAPP) was planned.

The procedure began by identifying both of the defects. After dissecting the right side, it was closed with continuous stratafix 2-0 suture and reinforced with a 12×12cm lightweight polypropylene mesh. The left-sided defect was closed using the same suture, and a 10×10cm mesh was placed. Both meshes overlapped the defects by at least 5 cm and were secured with absorbable tackers. The peritoneal flaps were also closed with the absorbable tackers. The procedure was completed without complication.

Bilateral Spigelian hernia is extremely rare, with few cases reported. These hernias have a high risk of complications. TAPP approach with primary closure and mesh reinforcement is safe, minimally invasive, and effective approach.

https://vimeo.com/1110838561/a0da04064f