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Weijie MO, Lee J. Technical considerations for laparoscopic transabdominal preperitoneal repair of concurrent Spigelian-inguinal hernia complex: A case report and review of literature. Asian J Endosc Surg 2023; 16:135-138. [PMID: 36039406 DOI: 10.1111/ases.13122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 07/26/2022] [Accepted: 08/13/2022] [Indexed: 01/05/2023]
Abstract
Spigelian hernia with concurrent inguinal hernia is not uncommon. The hernia location makes conventional laparoscopic repair challenging and this is commonly repaired by the open method. We present the technical considerations and feasibility, as well as literature review, of such a hernia repaired via a minimally invasive fashion. We performed a laparoscopic transabdominal preperitoneal hernia repair for a 59-year-old woman who presented with symptomatic irreducible large Spigelian-inguinal complex hernia, with a hernia neck of 4 cm on computed tomography scan. The hernia contents were reduced transabdominally and subsequently, the preperitoneal space was created via a transabdominal preperitoneal method to allow for hernia defect closure and subsequent mesh placement. The patient was discharged on postoperative day 2 without complication. At 6 months follow-up, she had no complications or recurrence. With increased experience, the laparoscopic repair of complex Spigelian-inguinal concurrent hernias is safe and feasible.
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Affiliation(s)
- Marc Ong Weijie
- Department of General Surgery, Khoo Teck Puat Hospital, Yishun, Singapore
| | - Jingwen Lee
- Department of General Surgery, Khoo Teck Puat Hospital, Yishun, Singapore
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Cui TYS, Law TT, Ng L, Wong KY. Spigelian hernia: Our total extraperitoneal approach and a systematic review of the literature. Asian J Endosc Surg 2021; 14:529-539. [PMID: 33393194 DOI: 10.1111/ases.12912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 12/07/2020] [Indexed: 01/27/2023]
Abstract
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.
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Affiliation(s)
| | - Tsz Ting Law
- Department of Surgery, Tung Wah Hospital, Hong Kong
| | - Lily Ng
- Department of Surgery, Tung Wah Hospital, Hong Kong
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Law TT, Ng KK, Ng L, Wong KY. Elective laparoscopic totally extraperitoneal repair for Spigelian hernia: A case series of four patients. Asian J Endosc Surg 2018; 11:244-247. [PMID: 29297987 DOI: 10.1111/ases.12454] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 11/09/2017] [Accepted: 11/28/2017] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Spigelian hernia (SH) is uncommon. Clinical diagnosis may be difficult, but computed tomography (CT) can help to establish the diagnosis. Laparoscopic repair is increasingly performed because it is associated with low morbidity rates. Laparoscopic approaches include transabdominal preperitoneal (TAPP), intraperitoneal onlay mesh (IPOM), and totally extraperitoneal (TEP). Here, we report our experiences of TEP repair for SH. METHODS A retrospective review was performed on all patients with SH who underwent elective laparoscopic TEP repair from 2007 to 2017 at Tung Wah Hospital, Hong Kong. RESULTS Four patients with SH were identified in the study period: three with a preoperative diagnosis of SH confirmed by CT scan and one diagnosed incidentally during TEP repair for inguinal hernia. The patients' mean age was 66.8 years (range, 55.0-82.0 years). The mean BMI was 22.8 kg/m2 (range, 20.8-23.6 kg/m2 ). The mean size of the SH defect was 2.0 cm (range, 0.5-3.0 cm). The mean operative time was 59 min (range, 40-86 min). Concomitant direct inguinal hernia was found in one patient and repaired simultaneously. All patients were discharged on postoperative day 1. One patient developed seroma, which subsided on conservative management. At a mean follow-up of 36 months (range, 2-108 months), there was no recurrence. CONCLUSION Laparoscopic repair for SH is preferred over the open approach as it is associated with a low morbidity rate and a short hospital stay. In our experience, TEP technique is safe and effective in laparoscopic SH repair.
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Affiliation(s)
- Tsz Ting Law
- Department of Surgery, Tung Wah Hospital, Hong Kong
| | - Ka Kin Ng
- Department of Surgery, Tung Wah Hospital, Hong Kong
| | - Lily Ng
- Department of Surgery, Tung Wah Hospital, Hong Kong
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Abstract
PURPOSE Spigelian hernias (SHs) account for 1% to 2% of abdominal wall hernias. Traditionally they have been repaired using an open technique. Since 1992, laparoscopic methods have become increasingly popular with various techniques being described in the literature. This systematic review aims to represent the current trends in laparoscopic repair of SHs. MATERIALS AND METHODS The databases MEDLINE and EMBASE were searched for appropriate terms regarding SH repair. Papers describing laparoscopic repair of SH were included. RESULTS Fifty articles were identified for the final review. No randomized controlled trials comparing laparoscopic techniques were identified. Two hundred thirty-seven SHs were repaired by various techniques. Intraperitoneal onlay mesh technique was the most popular repair method with minimal complications and recurrences reported in all techniques. CONCLUSIONS There are a number of laparoscopic techniques available to the surgeon repairing a SH. Overall, laparoscopic repair of the SH is a safe and acceptable method.
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Matsui S, Nitori N, Kato A, Ikeda Y, Kiatagwa Y, Hasegawa H, Okabayashi K, Tsuruta M, Kitajima M. Laparoscopic totally extra-peritoneal hernia repair for bilateral Spigelian hernias and coincident inguinal hernia: A case report. Int J Surg Case Rep 2016; 28:169-172. [PMID: 27718434 PMCID: PMC5061312 DOI: 10.1016/j.ijscr.2016.09.053] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 09/25/2016] [Accepted: 09/28/2016] [Indexed: 11/25/2022] Open
Abstract
Laparoscopic exploration is important to precise diagnosis of ventral hernia. Laparoscopic totally extra-peritoneal repair is feasible for Spigelian hernia. Laparoscopic exploration is also important after repairing ventral hernia. Abdominal CT in the abdominal position is useful to precise diagnosis of hernia.
Introduction Spigelian hernia (SH) is a rare ventral hernia occurring near the lateral border of the rectus muscle. The treatment remains controversial and depends on institutional expertise. Although laparoscopic surgery is a good adaptation for the repair of ventral hernias, only a few cases have been reported in the literature. Here, we report a case of totally extra-peritoneal (TEP) repair for bilateral SHs. Presentation of case A 74-year-old Japanese man presented with asymptomatic bulges in the right lower abdominal quadrant. On physical examination, the bulges were located to the right of the lateral border of the abdominal rectus muscle and the right inguinal region in an upright position. We diagnosed right SH and coincident homonymous ipsilateral inguinal hernia (IH) by abdominal computed tomography and planned a curative operation by laparoscopy. By first laparoscopic exploration, we found an asymptomatic SH to the left of the lateral border of the abdominal rectus muscle and performed TEP repair for all hernias. The second laparoscopic exploration after fixing the mesh in place revealed that the orifice of the right SH was scarred and stiffened by repeated prolapse. We finally eliminated the sac by ligation because of a fear causing of reduction en masse of the SH. Discussion and conclusion The use of laparoscopy simplified the diagnosis and facilitates the subsequent repair of the hernia. TEP approach is the ideal treatment for the simultaneous laparoscopic repair of SH and IH.
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Affiliation(s)
- Shimpei Matsui
- Department of Gastroenterology Center, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo 108-8329, Japan.
| | - Nobuhiro Nitori
- Department of Gastroenterology Center, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo 108-8329, Japan
| | - Ayu Kato
- Department of Gastroenterology Center, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo 108-8329, Japan
| | - Yoshifumi Ikeda
- Department of Gastroenterology Center, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo 108-8329, Japan
| | - Yuko Kiatagwa
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-0016, Japan
| | - Hirotoshi Hasegawa
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-0016, Japan
| | - Koji Okabayashi
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-0016, Japan
| | - Masashi Tsuruta
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-0016, Japan
| | - Masaki Kitajima
- Department of Surgery, Sanno Hospital, 8-10-16 Akasaka, Minato-ku, Tokyo 107-0052, Japan
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Tran H, Tran K, Zajkowska M, Lam V, Hawthorne WJ. Single-incision laparoscopic repair of Spigelian hernia. JSLS 2016; 19:e2015.001644. [PMID: 25722629 PMCID: PMC4325554 DOI: 10.4293/jsls.2015.001644] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction: Spigelian hernias represent only 1% to 2% of all abdominal wall hernias. The treatment, however, remains controversial but depends on institutional expertise. This case series reports the first experience with single-incision laparoscopic totally extraperitoneal (SILTEP) repair of Spigelian hernias with telescopic extraperitoneal dissection in combination with inguinal hernia repair. Methods: From February 2013 to April 2014, all patients referred with inguinal or Spigelian hernias, without histories of extraperitoneal intervention, underwent SILTEP repair with telescopic extraperitoneal dissection. A single-port device, 5.5 mm/52 cm/30° angled laparoscope, and conventional straight dissecting instruments were used for all cases. Extraperitoneal dissection was performed under direct vision with preservation of preperitoneal fascia overlying retroperitoneal nerves. Inguinal herniorrhaphy was performed with lightweight mesh that covered low-lying Spigelian defects. High-lying Spigelian defects were repaired with additional mesh. Results: There were 131 patients with 186 (92 direct) inguinal hernias and 7 patients with 8 Spigelian hernias (6 incidental, including 1 bilateral and 2 preoperatively diagnosed), with a mean age of 51.3 years and a mean body mass index of 25.1 kg/m2. An additional piece of mesh was used for 3 hernias. All Spigelian hernias were associated with direct inguinal hernias, and 8 combined inguinal and Spigelian hernias were successfully repaired with SILTEP repair with telescopic extraperitoneal dissection as day cases. There were no clinical recurrences during a mean follow-up period of 6 months (range, 1–15 months). Conclusions: Combined Spigelian and inguinal hernias can be successfully treated with SILTEP herniorrhaphy with telescopic extraperitoneal dissection. The high incidence of Spigelian hernias associated with direct inguinal hernias suggests a high index of suspicion for Spigelian hernias during laparoscopic inguinal herniorrhaphy.
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Affiliation(s)
- Hanh Tran
- Discipline of Surgery, Sydney Medical School, University of Sydney at Westmead Hospital, Westmead, Australia
| | - Kim Tran
- Sydney Hernia Specialists Clinic, Sydney, Australia
| | | | - Vincent Lam
- Discipline of Surgery, Sydney Medical School, University of Sydney at Westmead Hospital, Westmead, Australia
| | - Wayne J Hawthorne
- Discipline of Surgery, Sydney Medical School, University of Sydney at Westmead Hospital, Westmead, Australia
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Barnes TG, McFaul C, Abdelrazeq AS. Laparoscopic Transabdominal Preperitoneal Repair of Spigelian Hernia—Closure of the Fascial Defect Is Not Necessary. J Laparoendosc Adv Surg Tech A 2014; 24:66-71. [DOI: 10.1089/lap.2013.0407] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Thomas G. Barnes
- Colorectal Unit, Department of Surgery, Warrington & Halton Hospitals NHS Foundation Trust, Warrington, United Kingdom
| | - Chris McFaul
- Colorectal Unit, Department of Surgery, Warrington & Halton Hospitals NHS Foundation Trust, Warrington, United Kingdom
| | - Ayman S. Abdelrazeq
- Colorectal Unit, Department of Surgery, Warrington & Halton Hospitals NHS Foundation Trust, Warrington, United Kingdom
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Sucandy I, Miles M, Gallagher S, Josloff RK. Spigelian Hernia, Diagnosis, and Minimally Invasive Repair: A Case Series of 11 Patients. Am Surg 2013. [DOI: 10.1177/000313481307900812] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Iswanto Sucandy
- Department of Surgery Abington Memorial Hospital Abington, Pennsylvania
| | - Melissa Miles
- Department of Surgery Abington Memorial Hospital Abington, Pennsylvania
| | - Sidhbh Gallagher
- Department of Surgery Abington Memorial Hospital Abington, Pennsylvania
| | - Robert K. Josloff
- Department of Surgery Abington Memorial Hospital Abington, Pennsylvania
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Laparoscopic Spigelian and Inguinal Hernia Repair With the Kugel Patch. Surg Laparosc Endosc Percutan Tech 2010; 20:e76-8. [DOI: 10.1097/sle.0b013e3181d68d4b] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Emergency and elective laparoscopic repair of spigelian hernias: two case reports and a review of the literature. Surg Laparosc Endosc Percutan Tech 2009; 19:e152-5. [PMID: 19692870 DOI: 10.1097/sle.0b013e3181aabe1c] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Diagnosing spigelian hernias through physical examination can be particularly challenging. Increasingly, laparoscopy is being used to both confirm the diagnosis and carry out therapeutic repair. Here, we describe 2 cases of successful laparoscopic repair of spigelian hernias using an Endocatch assisted sutured technique. A review of the literature describing the role of laparoscopy in the management of spigelian hernia is also provided.
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Simultaneous Laparoscopic Totally Extraperitoneal Repair for Concurrent Ipsilateral Spigelian and Indirect Inguinal Hernia. Surg Laparosc Endosc Percutan Tech 2008; 18:414-6. [DOI: 10.1097/sle.0b013e318175dde4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bittner JG, Edwards MA, Shah MB, Macfadyen BV, Mellinger JD. Mesh-Free Laparoscopic Spigelian Hernia Repair. Am Surg 2008. [DOI: 10.1177/000313480807400808] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Varied Spigelian hernia mesh repair techniques have been described, although evidence suggests laparoscopy results in less morbidity and shorter hospitalization compared with open procedures. Laparoscopic suture repair of Spigelian hernias is rarely reported. Two patients with small Spigelian hernias (≤2 cm) were diagnosed and repaired laparoscopically using a transabdominal suture technique. Under laparoscopic guidance, a suture-passer was used to place two or three transfacial, interrupted 0 polypropylene sutures along the horizontal plane of the defect. Sutures were tied extracorporeally and closure was confirmed laparoscopically. These cases spurred a review of world literature (2001–2007) including clinical characteristics, operative techniques, and urgency of operations in Spigelian hernia patients. Data were compared using Fisher's exact test. One year postoperatively, the patients are without sequelae or recurrence. Literature review demonstrated most patients were females ( P < 0.001), ranged in age from 60 to 80 years ( P = 0.042), and presented with left-sided hernias ( P = 0.026). Open mesh repair (182/392 cases; 47%) was the most common technique; however, increasingly articles describe laparoscopic mesh repair. Mesh-free laparoscopic suture repair is feasible and safe. This novel uncomplicated approach to small Spigelian hernias combines the benefits of laparoscopic localization, reduction, and closure without the morbidity and cost associated with foreign material.
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Affiliation(s)
- James G. Bittner
- From the Section of Gastrointestinal Surgery, Department of Surgery, Medical College of Georgia School of Medicine, Augusta, Georgia
| | - Michael A. Edwards
- From the Section of Gastrointestinal Surgery, Department of Surgery, Medical College of Georgia School of Medicine, Augusta, Georgia
| | - Malay B. Shah
- From the Section of Gastrointestinal Surgery, Department of Surgery, Medical College of Georgia School of Medicine, Augusta, Georgia
| | - Bruce V. Macfadyen
- From the Section of Gastrointestinal Surgery, Department of Surgery, Medical College of Georgia School of Medicine, Augusta, Georgia
| | - John D. Mellinger
- From the Section of Gastrointestinal Surgery, Department of Surgery, Medical College of Georgia School of Medicine, Augusta, Georgia
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López-Tomassetti Fernández EM, Martín Malagón A, Delgado Plasencia L, Arteaga González I. Laparoscopic repair of incarcerated low spigelian hernia with transperitoneal PTFE DualMesh. Surg Laparosc Endosc Percutan Tech 2007; 16:427-31. [PMID: 17277661 DOI: 10.1097/01.sle.0000213728.80332.c8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
There are different types of hernias that can develop at certain sites in the abdominal wall. Spigelian hernia (SH) is a protrusion of abdominal contents through a defect in the spigelian aponeurosis, in proximity to the external margin of the rectus muscle. Usually, abdominal wall hernia sac contains the omentum but may also contain small intestine that might become trapped in the hernia. When ischemia of herniated contents is suspected, urgent surgical treatment is advocated. Elective laparoscopic repair of SH is still under discussion. However, a recent randomized study comparing open and laparoscopic repair as elective treatment suggested that extraperitoneal laparoscopic repair is the technique that offers best results for the patients. Recent development of new biologic materials and technologies in laparoscopy has led to improved results. We report the successful repair of incarcerated low SH that was successfully managed by urgent laparoscopic intraperitoneal onlay polytetrafluoroethylene mesh hernioplasty.
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Moreno Egea A, Aguayo Albasini JL. Re: Extraperitoneal Laparoscopic Approach to Spigelian Hernia Combined With Groin Hernias. Surg Laparosc Endosc Percutan Tech 2005; 15:117; author reply 117-8. [PMID: 15821631 DOI: 10.1097/01.sle.0000160291.85911.56] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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