Laparoscopic repair of an incarcerated Spigelian hernia - a video vignette.

Spigelian hernia (SH) is an uncommon ventral abdominal hernia characterized by a defect in the linea semilunaris. It represents 1–2% of all abdominal wall hernias 1. Traditionally, repair has been done with an open technique but the minimally invasive laparoscopic approach is becoming more common. We present a case (Video S1) of an incarcerated SH that was repaired successfully with the laparoscopic transabdominal preperitoneal (TAPP) technique. The hernia sac contained omentum. There was no necrotic bowel. A mesh was used to repair the fascial defect. Few randomized controlled trails have directly compared open surgery with the laparoscopic technique for repairing SHs. In a review, Mareno‐Egea et al . compared open versus laparoscopic surgical repair in nonincarcerated SHs 2. No significant difference was found in hernia recurrence between the two groups after a 3.5‐year follow‐up. There were, however, significant differences in morbidity and hospital stay in favour of the laparoscopic group. The average length of stay for patients having an open surgical repair was 5 days, compared with 1 day for those having a laparoscopic repair. Our experience is similar to the data emerging from the literature. A minimally invasive approach for SH repair, even if complicated, is safe and feasible; it restores the anatomy and prevents postoperative complications and has a reduced hospital stay, a quicker recovery and fewer seromas and infections.