PMC6039962_01
CT scan coronal view showing bilateral inguinal herniae (green arrows) and a left sided spigelian hernia (orange arrow).
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An incidental left Spigelian hernia was diagnosed (Figs. 1, 2).
CT scan axial view showing the spigelian hernia (green arrow).
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An incidental left Spigelian hernia was diagnosed (Figs. 1, 2).
Left Inguinal hernia (blue arrow) and left spigelian hernia (green arrow).
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Laparoscopic examination revealed two inguinal herniae as well as a left Spigelian hernia about five centimeters superior to the left direct inguinal hernia and lateral to the rectus muscle (Figs. 3, 4).
Preperitoneal exposure of the spigelian hernia neck (blue arrow).
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Laparoscopic examination revealed two inguinal herniae as well as a left Spigelian hernia about five centimeters superior to the left direct inguinal hernia and lateral to the rectus muscle (Figs. 3, 4).
Intra-corporeal suturing of the spigelian hernia neck with V-Loc suture (blue arrow).
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On the left side of the anterior abdominal wall, superior and inferior peritoneal flaps were raised; the superior flap was dissected cepahalad until the Spigelian hernia was exposed (Fig. 5) and the hernial contents reduced.
Pre-peritoneal mesh (TAPP approach) covering the inguinal (orange arrow) and spigelian (green arrow) herniae.
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The Spigelian hernia neck was then closed by intra-corporeal suturing with a V-loc  suture (Fig. 6).
Reperitonealisation of the Left inguinal area.
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Cooper's ligament and superiorly to the anterior abdominal wall (Fig. 7) using Absorbatack  absorbable tacks. Closure of the peritoneal flaps using AbsorbaTack  absorbable tacks (Fig. 8) resulted in reperitonealisation of the left sided anterior abdominal wall.
Right Inguinal hernia (blue arrow) and right round ligament (green arrow).
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Cooper's ligament and superiorly to the anterior abdominal wall (Fig. 7) using Absorbatack  absorbable tacks. Closure of the peritoneal flaps using AbsorbaTack  absorbable tacks (Fig. 8) resulted in reperitonealisation of the left sided anterior abdominal wall.