PDF(Pubmed)
Abstract：
Spigelian hernias are an uncommon protrusion defect noted between the rectus abdominis and the transversus abdominis muscles, at the semilunar line, with a low incidence of approximately 0.12% to 2% of all ventral hernias. Furthermore, the incidence of bilateral cases is noted to be even lower in the general population. They are associated with bowel incarceration and strangulation; hence surgical repair is indicated. Therapeutic alternatives for Spigelian hernias include open repair, however laparoscopic repair stands as the standard of care in these cases. Feasible and successful robotic repair has been reported, with associated advantages in terms of visualization and surgical instrument dexterity. We present the first ever reported cases of bilateral Spigelian hernias repaired using robotic approach. Two female Puerto Rican patients referred to our institution complaining of abdominal pain, where imaging studies found bilateral Spigelian hernias. In both cases, a transabdominal preperitoneal repair was performed using the Da Vinci Surgical System. Both patients were discharged home tolerating oral intake with adequate wound healing. On follow up visits, patients denied abdominal discomfort and had adequate wound healing. Robotic surgery for Spigelian hernias poses an advantage over laparoscopic repair as improved visualization, mobility, and precision in movements allow for more gentle tissue manipulation. Furthermore, this is the first evidence of safe and effective repair in the uncommon entity of bilateral cases, providing a newer alternative in the setting of such presentation.
摘要：
Spigelian疝是在腹直肌和腹横肌之间发现的一种罕见的突出缺陷。在半月线，所有腹侧疝的发病率约为0.12％至2％。此外，在普通人群中，双侧病例的发生率甚至更低。它们与肠嵌顿和绞窄有关；因此需要手术修复。治疗方法包括开放修复,然而，在这些情况下，腹腔镜修复是护理标准。据报道，机器人修复是可行和成功的，在可视化和手术器械灵活性方面具有相关优势。我们介绍了首次报道的使用机器人方法修复的双侧Spigelian疝病例。两名波多黎各女性患者提到我们的机构抱怨腹痛，影像学检查发现双侧Spigelian疝.在这两种情况下，使用达芬奇外科系统进行了经腹腹膜前修复。两名患者均出院，耐受口腔摄入，伤口愈合充分。关于后续访问，患者否认腹部不适，并有足够的伤口愈合。机器人手术在改进可视化方面优于腹腔镜修复，移动性,和运动精度允许更温和的组织操作。此外，这是在罕见的双边病例中安全有效修复的第一个证据，在这种演示的设置中提供了一个更新的替代方案。
