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.

Laparoscopic Spigelian Hernia Repair: A Systematic Review

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.

Emergent laparoscopic repair of a spigelian hernia: case report and review of the literature

A spigelian hernia is a protrusion through an anterior abdominal wall defect along the linea semilunaris. The traditional method of repair consists of an open surgical technique requiring a lengthy abdominal incision to allow visualization of the defect. However, with the emergence and availability of laparoscopic techniques, a minimally invasive approach is feasible. Only eight prior case reports have documented emergent laparoscopic repair of a spigelian hernia. We describe the first successful laparoscopic repair of a spigelian hernia in an emergent setting at our institution.

Spigelian hernia repair as a day-case procedure

PURPOSE

Only a few series of patients with a spigelian hernia managed on an outpatient basis have been reported in the literature. The aim of this prospective study was to evaluate the results of the elective spigelian hernia repair as an ambulatory procedure.

METHODS

From June 2007 to June 2010, 8 patients with 9 spigelian hernias were electively operated on under local anesthesia as a day case. Four patients had unilateral spigelian hernia, 1 had spigelian and inguinal on the same side, 1 had spigelian and epigastric, 1 had spigelian and umbilical, and 1 patient had bilateral spigelian and umbilical hernia. Spigelian hernia was managed by the "open preperitoneal flat mesh technique." In patients with several ventral hernias at different sites, "the open preperitoneal flat mesh technique" was performed using one separate flat mesh for each of the hernias; for the patient with inguinal hernia, the Lichtenstein procedure was performed in addition.

RESULTS

No complications and recurrences were recorded during a mean follow-up of 23.5 months (range: 11-35).

CONCLUSION

The elective spigelian hernia can be successfully repaired under local anesthesia as a day-case procedure. The "open preperitoneal flat mesh technique" provides excellent results under these conditions.

Multicentre prospective feasibility study on the repair of hernias and incisional ventral hernias with an innovative Tintrap mesh

BACKGROUND

The aim of this study is to assess an innovative prosthesis Tintrap Mesh and its inserter in the repair of hernias and incisional ventral hernias. The inserter helps the deployment of the mesh the same way an umbrella would open, which prevents the enlargement of the wound.

METHOD

Four centres took part in this study. A questionnaire was completed preoperatively, postoperatively and after 1 month of surgery. Data on pain and complications, patients' satisfaction, as well as the ease of installation and the quality of deployment of the mesh was gathered and assessed.

RESULTS

From January 2009 to December 2009, 80 patients were assessed. The prosthesis, ease of installation and the deployment quality were rated "very good" and "good". The average operating room time was 20.86 min (range: 10-50 min). Postoperative pain was rated level 0 and 3 on VAS score in 73 cases (91.25%). After 1 month, no occlusion or relapse were reported on 77 patients; 82.47% of patients had no pain. One seroma required the removal of the mesh.

CONCLUSION

The first set of results on 80 cases is encouraging judging by the simplicity of implantation, low postoperative pain and patient's satisfaction.

Emergency and elective laparoscopic repair of spigelian hernias: two case reports and a review of the literature

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.