Facilitation of open spigelian hernia repair by laparoscopic location of the hernial defect

Excerpt

We read with much interest the article by Iswariah and colleagues describing the case of a 42-year-old man who underwent laparoscopically assisted open repair of a tiny symptomatic spigelian hernia that had been missed during a surgical exploration 2 months earlier [2]. Our recent experience with a similar case lent further support to the authors’ contention that laparoscopy is an eminently efficacious tool for the detection of small or clinically impalpable spigelian hernias. Interestingly, in our patient, after a nonrevealing preperitoneal exploration, laparoscopy immediately located not one, but two hernial orifices on the same side of the anterior abdominal wall, although the patient had complained preoperatively of only one small bulge lateral to the rectus abdominis muscle (Fig. 1a). To our knowledge, there was one prior case of ipsilateral double hernia among the 18 laparoscopically diagnosed spigelian hernias reported to date [1]. Given the fact that the estimated incidence of multiple ipsilateral spigelian hernias was a mere 0.7% in an extensive review of 876 cases in the prelaparoscopic era, the inordinately high laparoscopy pickup rate of 2 cases in 19 (10.5%) reaffirms the diagnostic capability of laparoscopy for this notoriously elusive hernia [4]. …