Spigelian疝腹腔镜修补手术技术的常见问题

Frequently Asked Questions on Operative Technique of Laparoscopic Repair of Spigelian Hernia

                               
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What is Laparoscopic Spigelian Hernia Repair?

This is a kind of surgical procedure wherein the surgeon will make a number of small incisions on the patient’s abdomen. These holes will serve as the passageway for a laparoscope and other surgical instruments needed during the procedure of Spigelian hernia. The laparoscope will serve as the surgeon’s “eye” during the procedure of Spigelian hernia. This is equipped with video camera to guide the doctor in collecting the Spigelian hernia sac during the repair. It is also an indispensable equipment needed as the surgeon pushes the sac to the abdominal cavity. This is sometimes called as “hernia surgery” or “laparoscopic spigelian heliogrhaphy”.

What are the common approaches used in Spigelian Hernia Repair?

There are 4 operative approaches currently used to correct Spigelian hernia. Among these are the conventional and endoscopic approaches. The other two include the transabdominal preperitoneal repair as well as the total extraperitoneal repair of Spigelian hernia.

How is the conventional method done for Spigelian hernia?

This approach is done by doing a transverse incision over the protuberance. The peritoneal sac is also exposed by incising the external oblique aponeurosis following the course of its fibers. Though the sac is usually filled with omentum, it can also be a part of the stomach, appendix, gall bladder or ovary. The abnormal opening on the hernial orifice is corrected by using prosthetic patch or sutures above the fascia or on the pre-peritoneal space.

How is the Spigelian hernia endoscopic approach done?

This is otherwise termed as IPOM or “Intraperitoneal Onlay Mesh Repair”. This method requires an open technique. This necessitates the use of a Veress needle to have the needed intraperitoneal access. The goal is to locate the hernia orifice and create ports with 10 cm distance away from the affected area. These form an arch around the hernia. The Spigelian hernia sac will be reduced of its contents before adhesiolysis is done. Synthetic mesh and sutures will also be employed.

                               
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How is total extraperitoneal Spigelian hernia repair done?

This is otherwise termed as “TEP”. It is done employing 3 midline ports. This is performed by creating an extraperitoneal space either through a balloon or an open access. Once the sac is identified, this will be completely reduced. A mesh overlap will be used by dissecting the peritoneum over the arcuate line creating a margin of 5 cm over the hernial defect.

How long will the operation of Spigelian hernia take?

This procedure of Spigelian hernia can be done in as short as 2 hours. And majority of patients who underwent such procedure are allowed to go home 48 hours postoperatively.

What type of anesthesia is used during the procedure of Spigelian hernia?

The patient will undergo local or general anesthesia is used for the surgery of Spigelian hernia. Laparoscopic repair is better in general anesthesia.

What are the possible complications of this procedure of Spigelian hernia?

The laparoscopic repair of spigelian hernia may lead to infection, bleeding or adverse reaction to anesthesia. However, this only happens in rare cases. Spigelian hernias are clinically elusive often until patient suffer from complication and strangulation occurs. Ultrasound examination of the semi lunar line is very simple and accurate method of diagnosis of spegelian hernia. Laparoscopic Surgery should always be advised by the surgeons once they see the patient. Apart from the discomfort these hernias cause, they strangulate frequently and hence should be repaired as soon as it is diagnosed.

Will there be chances of recurrence of Spigelian hernia after the operation?

Such procedure has a good prognosis. Majority of laparoscopic surgeries for Spigelian hernia came out to be successful. In fact, there were only very few reported recurrence after the repair was done. Most spigelian hernias occur below the level of the umbilicus close to the level of the arcuate line so after good repair the recurrence is not very common, though they have being reported to occur above the level of the umbilicus. Incisional hernias through the spigelian fascia or line conventionally are not considered as spigelian hernia, though some authors have described them as spigelian hernia