Laparoscopic Spigelian Hernia Repair: The Scroll Technique

Abstract

Spigelian hernia is a rare clinical entity. It has a subtle clinical presentation with vague abdominal pain that may warrant laparoscopy. Even though laparoscopic ventral hernia repair is increasingly popular, laparoscopic repair of spigelian hernia has not been adequately studied. Eight patients who underwent laparoscopic spigelian hernia repair are presented herein, along with a description of our simple technique for mesh placement. In addition, literature review of laparoscopic repair of spigelian hernia is also presented. Our case series included six females and two males; two patients presented acutely whereas the others presented with chronic pain. Laparoscopic repair was successfully performed in all of our patients with a mean operative time of 92.5 minutes. There were no postoperative complications or recurrence with a mean follow up of 36 months. Our scroll technique for laparoscopic repair is simple and feasible. It minimizes intra-corporeal mesh manipulation, facilitates mesh fixation to the anterior abdominal wall, and maintains a precise orientation of the mesh in relation to the defect.

Emergency Intraperitoneal Onlay Mesh Repair of Incarcerated Spigelian Hernia

“…Until 1992, the main stay of repair for Spigelian hernias was open mesh repair, when for the first time it was repaired laparoscopically. 2 Since then, various laparoscopic suture or mesh repairs utilizing a range of techniques like transabdominal preperitoneal repair (TAPP), 5 totally extraperitoneal repair (TEP), 6 and scroll technique 7 have been described. A variety of meshes have also been used, such as polypropylene, 8 polytetrafluoroethylene (PTFE), 9 and composite.…”

Spigelian Hernia : A Diagnostic Dilemma

“…Laparoscopic techniques also evolved to address SH like Totally extraperitoneal laparoscopic Spigelian hernia repair [TEP] [16,17], Intraperitoneal Onlay Mesh repair [IPOM] [13] and Transabdominal Preperitoneal repair [18]. A modication of IPOM popular as Scroll technique, is a much easier approach, and involves less intraperitoneal mesh handing, has higher success rates, and lower recurrence rates than IPOM [19].…”