Case presentation of strangulated Spigelian hernia presenting with localized peritonitis repaired laparoscopically. Includes intra-operative images. Dr. Mohamad Al-Gailani FRCS الدكتور محمد الكيلاني Chief of Surgery Al Hammadi Hospital, Nuzha مستشفى الحمادي, النزهة Riyadh, KSA الرياض, المملكة العربية السعودية

1. LAPAROSCOPIC REPAIR
OF STRANGULATED
SPIGELIAN HERNIA
DR. MOHAMAD AL-GAILANI FRCS ‫الكيالني‬ ‫محمد‬ ‫الدكتور‬
Chief of Surgery
Al Hammadi Hospital, Nuzha
Riyadh, KSA ‫السعودية‬ ‫العربية‬ ‫المملكة‬

2. THE CASE
• 30 Year Old Male Patient
• 3 Days History Of Severe Right
Sided Abdominal Pain
• No Nausea, No Vomiting,
Bowels Normal, Fit Otherwise
• On Exam Tenderness And
Rebound Tenderness Right Side
Abdomen
• Diagnosis: Localized Peritonitis
• US: Small Gall Bladder Stones,
Otherwise Normal
• CT Scan: Right Lumbar
Omental Infarction, Small Gall
Bladder Stones, Normal
Appendix, No Ascitis Or
Localized Fluid Collection
Laparoscopic Repair of Strangulated Spigelian Hernia Dr. Mohamad Al-Gailani Riyadh, KSA ‫الكيالني‬ ‫محمد‬ ‫الدكتور‬
2

3. Laparoscopic Repair of Strangulated Spigelian Hernia Dr. Mohamad Al-Gailani Riyadh, KSA ‫الكيالني‬ ‫محمد‬ ‫الدكتور‬
3
OMENTAL
INFARCTION
CT SCAN

4. MANAGEMENT
• Admit
• Nil By Mouth, IV Fluids, Tramadol 100 mg IV PRN,
Cefuroxime 750 Mg + Metronidazole 500 Mg IV
• Differential Diagnosis:
• Acute Appendicitis, Acute Cholecystitis, Omental
Infarction, Cause?
• For Diagnostic Laparoscopy And Proceed
Laparoscopic Repair of Strangulated Spigelian Hernia Dr. Mohamad Al-Gailani Riyadh, KSA ‫الكيالني‬ ‫محمد‬ ‫الدكتور‬
4

5. DIAGNOSTIC LAPAROSCOPY
• Open Insertion 10 mm Umbilical + 10 mm Right + 5 mm Left
Laparoscopic Ports
• Findings:
• Omentum Stuck To Ant. Abdominal Wall On The Right
• Parietal Peritonitis
• Normal Appendix
• Non-inflammed Gall Bladder
• Rest Normal
Laparoscopic Repair of Strangulated Spigelian Hernia Dr. Mohamad Al-Gailani Riyadh, KSA ‫الكيالني‬ ‫محمد‬ ‫الدكتور‬
5

6. Laparoscopic Repair of Strangulated Spigelian Hernia Dr. Mohamad Al-Gailani
Riyadh, KSA ‫الكيالني‬ ‫محمد‬ ‫الدكتور‬
6
DIAGNOSTIC LAPAROSCOPY
OMENTUM STUCK TO ANT. ABDOMINAL WALL
PARIETAL
PERITONITIS

7. Laparoscopic Repair of Strangulated Spigelian Hernia Dr. Mohamad Al-Gailani
Riyadh, KSA ‫الكيالني‬ ‫محمد‬ ‫الدكتور‬
7UNDERLYING
STRANGULATED
SPIGELIAN
HERNIA

8. Laparoscopic Repair of Strangulated Spigelian Hernia Dr. Mohamad Al-Gailani
Riyadh, KSA ‫الكيالني‬ ‫محمد‬ ‫الدكتور‬
8
RELEASING THE
ADHERANT
OMENTUM

9. Laparoscopic Repair of Strangulated Spigelian Hernia Dr. Mohamad Al-Gailani
Riyadh, KSA ‫الكيالني‬ ‫محمد‬ ‫الدكتور‬
9RIGHT SPIGELIAN
HERNIA WITH
INCARCERATED
OMENTUM

10. Laparoscopic Repair of Strangulated Spigelian Hernia Dr. Mohamad Al-Gailani Riyadh, KSA ‫الكيالني‬ ‫محمد‬ ‫الدكتور‬
10
RIGHT RECTUS ABDOMINIS
MUSCLE
RIGHT SPIGELIAN HERNIA
SPIGELIAN
APONEUROSIS/FASCIA
SPIGELIAN HERNIA ANATOMY

11. 11
Laparoscopic Repair of Strangulated Spigelian Hernia Dr. Mohamad Al-Gailani
Riyadh, KSA ‫الكيالني‬ ‫محمد‬ ‫الدكتور‬
THE ADHERENT
ISCHAEMIC OMENTAL
“CAKE” COMPLETELY
SEPERATED

12. 12
THE ISCHAEMIC
OMENTAL “CAKE”
AFTER RELEASE FROM
THE HERNIA
INCARCERATED
OMENTUM IN
SPIGELIAN
HERNIA
Laparoscopic Repair of Strangulated Spigelian Hernia Dr. Mohamad Al-Gailani
Riyadh, KSA ‫الكيالني‬ ‫محمد‬ ‫الدكتور‬

13. Laparoscopic Repair of Strangulated Spigelian Hernia Dr. Mohamad Al-Gailani
Riyadh, KSA ‫الكيالني‬ ‫محمد‬ ‫الدكتور‬
13
MOBILIZING
INCARCERATED
OMENTUM IN
THE SPIGELIAN
HERNIA

14. Laparoscopic Repair of Strangulated Spigelian Hernia Dr. Mohamad Al-Gailani
Riyadh, KSA ‫الكيالني‬ ‫محمد‬ ‫الدكتور‬
14
OMENTAL CONTAINT
OF INCARCERATED
SPIGELIAN HERNIA

15. Laparoscopic Repair of Strangulated Spigelian Hernia Dr. Mohamad Al-Gailani
Riyadh, KSA ‫الكيالني‬ ‫محمد‬ ‫الدكتور‬
15
COMPLETING
EMPTYING
HERNIA CONTAINT

16. Laparoscopic Repair of Strangulated Spigelian Hernia Dr. Mohamad Al-Gailani
Riyadh, KSA ‫الكيالني‬ ‫محمد‬ ‫الدكتور‬
16

17. Laparoscopic Repair of Strangulated Spigelian Hernia Dr. Mohamad Al-Gailani
Riyadh, KSA ‫الكيالني‬ ‫محمد‬ ‫الدكتور‬
17
NECK OF SPIGELIAN HERNIA

18. Laparoscopic Repair of Strangulated Spigelian Hernia Dr. Mohamad Al-Gailani
Riyadh, KSA ‫الكيالني‬ ‫محمد‬ ‫الدكتور‬
18
PROCEED ™
(DUAL FACE) 10 X 15 CM MESH
MESH REPAIR RIGHT SPIGELIAN HERNIA

19. Laparoscopic Repair of Strangulated Spigelian Hernia Dr. Mohamad Al-Gailani
Riyadh, KSA ‫الكيالني‬ ‫محمد‬ ‫الدكتور‬
19

20. Laparoscopic Repair of Strangulated Spigelian Hernia Dr. Mohamad Al-Gailani
Riyadh, KSA ‫الكيالني‬ ‫محمد‬ ‫الدكتور‬
20
PROTAC™
FIXATION OF MESH

21. Laparoscopic Repair of Strangulated Spigelian Hernia Dr. Mohamad Al-Gailani
Riyadh, KSA ‫الكيالني‬ ‫محمد‬ ‫الدكتور‬
21

22. Laparoscopic Repair of Strangulated Spigelian Hernia Dr. Mohamad Al-Gailani
Riyadh, KSA ‫الكيالني‬ ‫محمد‬ ‫الدكتور‬
22

23. Laparoscopic Repair of Strangulated Spigelian Hernia Dr. Mohamad Al-Gailani
Riyadh, KSA ‫الكيالني‬ ‫محمد‬ ‫الدكتور‬
23
MESH REPAIR COMPLETED

24. POSTOPERATIVE
•Uneventful Recovery.
•Patient Discharged On Second Postoperative
Day.
Laparoscopic Repair of Strangulated Spigelian Hernia Dr. Mohamad Al-Gailani Riyadh, KSA ‫الكيالني‬ ‫محمد‬ ‫الدكتور‬
24

25. SPIGELIAN HERNIA
• Protrusion Of Preperitoneal Fat, Omentum, Peritoneal Sac
Or Viscera Through A Congenital Or Acquired Defect In The
Spigelian Aponeurosis.
• Rare, Represents 1-2% Of All Abdominal Hernia.
• Most Occur Below The Umbilicus At The Level Of The
Arcuate Line.
• This Is The 3rd Case Dealt With By The Author.
• The Previous 2 Cases (In The UK) Had Small Bowel
Herniated And Were Also Repaired Laparoscopically.
Laparoscopic Repair of Strangulated Spigelian Hernia Dr. Mohamad Al-Gailani Riyadh, KSA ‫الكيالني‬ ‫محمد‬ ‫الدكتور‬
25

26. Laparoscopic Repair of Strangulated Spigelian Hernia Dr. Mohamad Al-Gailani
Riyadh, KSA ‫الكيالني‬ ‫محمد‬ ‫الدكتور‬