Spigelian hernia diagnosed in a newborn: A case report

Introduction: Spigelian hernias represent only 0.1-0.2 % of all abdominal wall hernias and are infrequently encountered in pediatric patients. Limited literature surrounding pediatric Spigelian hernias exists, and there is no uniform or optimal surgical repair technique. Case presentation: A term female with unremarkable prenatal history presented a left-sided Spigelian hernia at birth that contained loops of bowel, by physical examination and ultrasound. The hernia was easily reducible, so she was discharged with a plan for an elective repair at a later point. At 8 months of age, she underwent an abdominal wall ultrasound that showed a defect of 6 cm in length. She underwent elective repair at 9 months of age due to parental preference in the setting of an enlarging defect size. The hernia repair was done through a combination of laparoscopic and open techniques. The laparoscopy part, which consisted in one port placed in the umbilicus for a camera, enabled visualization of the suspected hernia site, confirm the proper approximation of the lateral and medial borders of the hernia, and helped avoid any intraabdominal injuries during the repair. The repair itself was completed in an open manner with interrupted sutures in a top to bottom approach, in a transverse orientation. The patient recovered well from the operation. At 1 year of follow up she has shown no signs of recurrence. Conclusion: Congenital pediatric Spigelian hernias can be successfully repaired using a combination of laparoscopy and open approach. The addition of a laparoscopy allows proper visualization of the intra-abdominal side of the repair.