PREOPERATIVE DIAGNOSIS: Spigelian hernia.
POSTOPERATIVE DIAGNOSIS: Spigelian hernia.
PROCEDURE PERFORMED: Spigelian hernia repair with mesh.
FINDINGS: The patient had a left-sided Spigelian hernia with incarcerated sigmoid colon through the hernia.
DESCRIPTION OF OPERATION: The patient was taken to the operating room and placed in the supine position. The patient was administered general endotracheal anesthesia. Her skin was prepped, and she was draped in the usual sterile fashion. The patient had a hernia down in the left lower quadrant. An incision was made overlying the bulge. The patient had a hernia sac in the subcutaneous tissue. The hernia sac was dissected free. She had an extremely attenuated external oblique muscle. This was freed up from the hernia sac. Just below this, she had a Spigelian hernia. We were able to free up the hernia sac from the internal oblique. This hernia was just lateral to the rectus abdominus. We were eventually able to dissect the sac away from the defect and reduce the sigmoid colon and sac back into the peritoneal cavity. The preperitoneal space was then developed bluntly. An extended Prolene hernia system mesh was then placed into the defect which measured approximately 2.5 cm. The posterior leaf of the mesh was deployed in the preperitoneal space. The connector device was attached to the internal oblique muscle with interrupted #0 Vicryl suture. The anterior leaf of the mesh was then placed beneath the external oblique muscle. The external oblique was reapproximated over the mesh. The external oblique, however, was extremely attenuated, as stated above. The wound was inspected, and hemostasis was achieved. The dermal tissue was reapproximated with 2-0 Vicryl in a running fashion. The skin was closed with staples. The wound was then infiltrated with 10 mL of 0.5% Marcaine with epinephrine. Sterile dressing was applied. The patient was awakened from anesthesia, having suffered no apparent intraoperative complications.