PMC5294734_01
First laparoscopic photograph taken after lysis of adhesions. Spigelian hernia visible with segment of trapped omentum.
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Upon removal of these adhesions, a Spigelian hernia was visible in the left lower quadrant, containing a segment of omentum (Fig. 1).
Visualization of the defect in the Spigelian fascia after reduction of trapped omental segment (a). A closer view of the defect in the Spigelian fascia (b).
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The segment of omentum trapped inside the Spigelian hernia was reduced and resected using a Harmonic scalpel , which permitted visualization of the defect in the Spigelian fascia (Fig. 2a,b).
(a) Laaparoscopic view after primary repair of the Spigelian defect and (b) Laparoscopic photograph after positioning and securing the mesh to the abdominal wall.
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The defect was repaired by approximating the tissues using a suture passer (Fig. 3a) and then secondarily reinforced using a 4 x 6 inch Proceed  mesh secured with sutures at the 3 and 9 o'clock position and then anchored to the abdominal wall using the Securestrap  fixation device (Fig. 3b).