A case of small spigelian hernias successfully treated by a simple laparoscopy-assisted technique

Clinical diagnosis and location of spigelian hernias is notoriously difficult, and the recommended repair techniques are many and varied. This report describes a case of ipsilateral double spigelian hernias treated by a laparoscopy-assisted technique hitherto undescribed. Suturing of the fascial defect was aided by a 14-gauge angiocatheter that had traversed the full thickness of the abdominal wall firstly on one side of the hernial defect under laparoscopic guidance. A strong suture was threaded down the angiocatheter sheath. Its intra-abdominal end was made to traverse the other side of the defect and resurface upon withdrawal of a snare loop made of a folded suture inserted through the angiocatheter after the latter had been redirected to puncture the opposite edge. The knot was tied extracorporeally. This technique provides the benefits of laparoscopic localization to be combined with the advantages derived from the novel use of an angiocatheter--simplicity, low cost, safety, minimized tissue trauma, and improved cosmesis. It is therefore recommended for selected cases of small spigelian hernias.