Laparoscopic totally extra-peritoneal hernia repair for bilateral Spigelian hernias and coincident inguinal hernia: A case report

Modified Laparoscopic Sugarbaker Repair of Parastomal Hernia With a Totally Extraperitoneal Technique

Purpose: Many patients develop a parastomal hernia within the first 2 years of stoma formation, and even surgical repair is associated with high recurrence rates. An intraperitoneal approach is typically used for the laparoscopic repair of parastomal hernia; it is unknown whether a totally extraperitoneal technique (TEP) is feasible. Here we describe a laparoscopic TEP approach using a modified Sugarbaker method for the repair of parastomal hernia.

Methods: Seven patients underwent parastomal hernia repair. The retrograde puncture technique was used to create the extrapneumoperitoneum, and the peritoneum was separated with a laparoscopic TEP approach; the mesh was placed using a modified Sugarbaker technique.

Results: All patients had an oncologic etiology for stoma creation. The mean (±SD) size of the hernia defect was 3.1 ± 2.7 cm and the mesh size was 303.4 ± 96.8 cm². The mean operative time was 195.5 ± 20.7 min and average length of hospital stay after surgery was 4.8 ± 2.1 days. One patient had intraoperative subcutaneous emphysema. The average follow-up time was 8.5 ± 2.7 months; mild pain occurred in 2 patients, 3 experienced seroma formation (with no special treatment required), and 1 had early intestinal obstruction (which was treated with conservative care). There was no hernia recurrence, wound complications, or infections of the surgical site or mesh during follow-up.

Conclusion: A laparoscopic TEP technique is technically challenging but feasible. Modified laparoscopic Sugarbaker repair of a parastomal hernia with the TEP technique is safe and effective, although the recurrence rate and late complications require confirmation in more cases with long-term follow-up.

Spigelian hernia: Our total extraperitoneal approach and a systematic review of the literature

INTRODUCTION

Spigelian hernia is a rare lateral ventral hernia traditionally repaired through open incision with extensive dissection. Three laparoscopic techniques have been reported in the literature: intraperitoneal onlay mesh (IPOM), transabdominal preperitoneal (TAPP), and total extraperitoneal (TEP). TEP is less popular than the other approaches. We evaluated TEP's safety and effectiveness and compared different laparoscopic techniques.

METHODS

All patients with Spigelian hernia who had undergone extended TEP (eTEP) repair with mesh in our center from January 2007 to February 2020 were studied. A three-port technique with a preperitoneal space created by telescope at the midline was adopted. A systematic review on laparoscopic mesh repair was performed by searching for "Spigelian hernia" and "laparoscopic" from 1999 to 2019 in the MEDLINE database.

RESULTS

Seven patients underwent eTEP repair for Spigelian hernia. Five presented with abdominal mass and underwent preoperative imaging. Two were diagnosed incidentally during TEP for inguinal hernia. The mean operative duration was 65 minutes (range, 40-93 minutes). There were no open conversions or intraoperative complications. The mean length of hospital stay was 1.4 days (range, 1-3 days). The mean follow-up period was 44.3 months. One patient developed seroma. There was no recurrence or chronic pain. We identified 197 laparoscopic mesh repairs reported in 41 articles. IPOM (n = 91) was the most popular approach, followed by TAPP (n = 70) and TEP (n = 36). Laparoscopic mesh repair of Spigelian hernia is safe and offers excellent outcomes.

CONCLUSION

We found the eTEP approach safe and effective for Spigelian hernia repair. IPOM, TAPP, and TEP are comparable.

Endoscopic Totally Extraperitoneal Repair of Parastomal Hernia: A Case Report

A parastomal hernia is a type of incisional hernia that occurs in abdominal integuments in the proximity of a stoma. It is a frequent late complication following colostomy. Surgical repair is currently the only treatment option for parastomal hernia. Here we present the case of a 74-year-old patient with parastomal hernia and a history of open surgery treated with a totally extraperitoneal (TEP) endoscopic approach. There was no recurrence of the hernia at the 3-month follow-up. We discuss the feasibility and possible operative approaches for endoscopic repair of parastomal hernia with the TEP technique.

Comparison between robotic and laparoscopic inguinal hernia repair in Caucasian patients: a systematic review and meta-analysis

Background

Laparoscopic and robotic techniques allow surgeons to dissect and observe the groin area from the inside out, this study was to evaluate and compare the effects and safety of robotic inguinal hernia repair (R-IHR) and laparoscopic inguinal hernia repair (L-IHR) in Caucasian patients.

Methods

We searched the full texts of studies comparing R-IHR and L-IHR in multiple databases. Meta-, sensitivity, and bias analyses of the included literature were performed with Review Manager 5.2, and forest plots were drawn. The joint estimate of the risk ratio (RR) and the mean difference (MD) of the 95% confidence interval (CI) was used as a measure of the effect size.

Results

This meta-analysis included 8 eligible studies involving 1,379 Caucasian patients with inguinal hernia (IH). No significant difference was found in pain score (MD =1.52, 95% CI, −0.30, 3.35, P=0.10; I²=97%), length of hospital stay (MD =0.14, 95% CI, −0.03, 0.30, P for overall effect =1.63, I²=0%), or complications (RR =1.24 with 95% CI, 0.94, 1.63, P for overall effect =0.13, I²=0%) between R-IHR and L-IHR. However, there was significant difference in operative time between R-IHR and L-IHR (MD =17.17, 95% CI, 6.32, 28.03, P=0.002; I²=84%).

Discussion

This meta-analysis revealed only minor differences between R-IHR and L-IHR in terms of clinical effects and safety in Caucasian patients, although R-IHR has a longer operative time than L-IHR. Both R-IHR and L-IHR are suitable to treat Caucasian patients with IH.

CTEP Versus LESS Totally Extraperitoneal Hernioplasty

Background and Objectives:

The authors sought to assess and compare the surgical outcomes of laparoendoscopic single-port surgery (LESS) for totally extraperitoneal (LESS-TEP) hernioplasty and conventional totally extraperitoneal (CTEP) hernioplasty.

Methods:

From March 2015 through May 2018, a retrospective analysis of postoperative outcomes was conducted that included 81 cases of LESS-TEP and 88 cases of CTEP hernioplasty patients. For postoperative indicator comparisons, a visual-analog pain scale and 5-level cosmesis evaluation sheet were applied. In addition, complications on postoperative outcomes following inguinal hernia repair surgery are discussed based on our analysis and surgical experience.

Results:

All operations were successfully performed at different hospitals. Compared with the CTEP group, the operative time in the LESS-TEP group increased significantly (P < .05). However, the cosmetic outcome in the LESS-TEP group was rated higher than that in the CTEP group (P < .05). There was no significant difference between the 2 groups in hospitalization time, the incidence of complications, postoperative pain levels, or medical costs (P > .05).

Conclusion:

LESS-TEP is as feasible and safe as CTEP. The use of LESS-TEP successfully improved the cosmetic outcomes of inguinal hernia repair surgery with smaller and fewer scars for patients. As a new surgical treatment approach for inguinal hernias, the LESS-TEP technique is still not a necessary or efficacious surgical alternative strategy for CTEP, especially for surgeons who are less experienced in the technique.

Laparoscopic herniorrhaphy of bilateral inguinal herniae and an incidental Spigelian hernia with intra corporeal suturing of the Spigelian hernia neck: A case report

INTRODUCTION

A Spigelian hernia is a rare type of abdominal wall hernia occurring in an area of congenital or acquired defect. These hernias occur in an area called the Spigelian zone and are interparietal making for a difficult diagnosis on clinical exam.

PRESENTATION OF CASE

A 74-year-old female presenting with bilateral inguinal herniae and a left sided Spigelian hernia. The repair was done laparoscopically with an intra-corporeal suture closing the Spigelian hernia neck. Her recovery was uneventful.

DISCUSSION

The aetiology of Spigelian herniae remains nebulous. Due to their rarity and evasive nature on clinical exam, ultrasound imaging has become the first line in diagnosis. Open herniorrhaphy is still the most common technique, but laparoscopic repair is becoming more commonplace in the surgical armamentarium.

CONCLUSION

Spigelian herniae are rare with non specific symptoms. We present the first case report of a laparoscopic repair of bilateral inguinal herniae and a left sided Spigelian hernia with intra-corporeal suturing of the Spigelian hernia neck.

Spigelian hernia in gynaecology

Background

A Spigelian hernia is a rare hernia through the Spigelian fascia between the rectus muscle and the semilunar line. This hernia is well known in surgery. Symptoms vary from insidious to localised pain, an intermittent mass and/or a bowel obstruction.

Results

The Spigelian hernia is poorly known in gynaecology. Spigelian hernias may be causally related to secondary trocar insertion. This review is written to increase awareness in gynaecology and is illustrated by a case report in which the diagnosis was missed for 4 years even by laparoscopy. Smaller hernias risk not to be diagnosed and will thus not be treated. Even larger Spigelian hernias might not be recognised and treated appropriately.

Conclusions

The gynaecologist should consider a Spigelian hernia in women with localised pain in the abdominal wall lateral of the rectus muscle some 5 cm below the umbilicus. Smaller hernias can be closed by laparoscopy without a mesh. Larger hernias require a mesh repair.