PMC5061312_01
Computed tomography showing right Spigelian hernia (1a) and right inguinal hernia (1b) (arrowheads).
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Abdominal computed tomography (CT) revealed a small fascial defect and intestinal prolapse from the abdominal cavity to the right of the lateral border of the abdominal rectus muscle, which was identified as SH and right inguinal hernia (IH) (Fig. 1a,b).
The first laparoscopic exploration photograph. The orifices of right Spigelian hernia (2a), right inguinal hernia (2b), and left asymptomatic Spigelian hernia (2c) were seen.
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We confirmed the orifice of the right SH (Fig. 2a) but also noticed that not only was the right IH an indirect one (Fig. 2b) but there was also an asymptomatic SH to the left of the lateral border of the abdominal rectus muscle (Fig. 2c).
Intraoperative photograph showing prolapsed right Spigelian hernia (3a), removed the hernia (3b), returned peritoneal edge (PE) of inguinal hernia (3c), and fixed polypropylene meshes (3d).
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The SH, which had prolapsed from the aponeurosis (Fig. 3a), was detected at the lateral side of the prolapsed region of the IH and the sac and peripheral adipose tissue to the PS were immediately removed (Fig. 3b). We separated the IH sac from these important organs and returned enough peritoneal edge (PE) to the PS (Fig. 3c). After peeling back the PE of the left side, we inserted a polypropylene mesh to the PS, and spread and fixed this to the Cooper's ligament or aponeurosis of the transversus abdominis muscles using a surgical stapler (Fig. 3d).
The second laparoscopic exploration photographs showing right scarred and stiffened orifice (4a) by repeated prolapse, left intact peritoneum (4b), and the final laparoscopic exploration photograph showing elimination of the sac by ligation.
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The second laparoscopic exploration revealed that the orifice of the right SH was scarred and stiffened by repeated prolapse (Fig. 4a). On the other hand, the orifice peritoneum of the left SH had reversed and became undone (Fig. 4b). We were able to eliminate the sac by ligation at the PS (Fig. 4c).
Computed tomography showing repairing the hernia and no recurrence.
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Routine follow-ups were performed, and no morbidity was encountered due to the procedure (Fig. 5).