Laparoscopic spigelian herniorraphy - general and visceral surgery

Position patient supine on OR Table, skin prep and drape (sterile!): Entire abdomen from costal arches to symphysis pubis. Incise skin on opposite side of hernia and enter abdomen in open fashion. Bluntly insert the 10 mm trocar and accomplish the pneumoperitoneum with an intra-abdominal pressure of about 12-15 mmHg.

Note:

It is up to the surgeon how he/she gains access to the abdomen. Open access is preferred. Because of numerous unnoticed injuries with at times lethal outcome, medical experts in legal proceedings have become more and more wary of the Verres needle.

Insert the laparoscope with the camera and inspect for possible injury and bleeding: In particular, carefully check for any adhesions in the immediate vicinity. Laparoscopic overview: Inspect all organs and look out for any pathologies. Insert the first 5 mm trocar. Always do this under visual camera control to minimize any risk of injury. The surgeon will determine the exact location based on his/her experience and preference. The second 5 mm working trocar will be inserted later on.

Inspect the hernia orifice Typically, this will be located between the aponeurosis of the transversus abdominis or internal oblique muscle (lateral margin) and the rectus sheath (medial margin) at the level of the arcuate line. The lateral margin is called linea semilunaris or Spieghelius line.