Editing Spigelian hernia (section)

== '''Technique''' ==

* Open anterior
** Transverse skin incision over protrusion
** Dissect down to EO
*** Usually need to open EO to see the hernia, and will see the sac or pre-peritoneal fat in the inter-parietal plane
*** If EO is exposed and it's unclear where the hernia is, palpate for the defect, then incise EO and bluntly open the plane between EO and IO to find the hernia
*** If EO is fibrotic from previous repair, open it in a separate area and then dissect towards the defect from normal to abnormal
** Dissect sac down to hernia neck
** To place mesh between EO and IO:
*** Separate external oblique from internal oblique for a 3cm circumference
*** Close internal oblique defect with running absorbable
*** Synthetic mesh between internal and external obliques (suture to rectus medially with nonabsorbable sutures)
** To place pre-peritoneal mesh:
*** Just treat it like a standard sub-lay Ventralex repair, creating a pre-peritoneal pocket
** Close external oblique
* TAPP/IPOM
* TEP 
** Dissecting balloon superficial to posterior rectus sheath
** Keep inferior epigastrics anterior to balloon to avoid tearing
** Insufflate 12mmHg
** 5mm trocars placed in midline between umbilicus and pubic symphysis
** Reduce sac, approximate edges, place mesh
* Open intra-peritoneal

[[Category:Abdo wall and retroperitoneum]]