IATROGENIC LAPAROSCOPIC SPIGELIAN HERNIA - A POSSIBLE CAUSE AND PREVENTION

Following laparoscopic hernia repair, small bowel herniation occurred through the posterior rectus sheath of a cannula site despite closure of the anterior sheath. The proposed mechanism was coalescence of two adjacent 12 mm defects, resulting from the re-introduction of a displa ced cannula. It is recommended that a displaced cannula be re-introduc ed along the original track using a blunt trocar. This should be done whilst observing the procedure with the video camera. Prevention of ca nnula site hernia can only be ensured with complete closure of both an terior and posterior rectus sheath.