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

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.

Epiploic appendagitis in a Spiegel hernia: A case report and review of the literature

“…Fever, nausea, diarrhea or constipation may be associated, but they are rarely present. Laboratory tests are usually within normal values and (in some cases) they may present a slightly elevated leucocytes and C-reactive protein count, due to ischemic necrosis of fatty tissue [11] . Its diagnosis is often determined after an abdominal computed tomography.…”

“…Its main characteristics are an oval lesion, measuring between 1.5 and 3.5 cm in diameter, with fat density, surrounded by a hyperdense ring due to the inflammatory reaction of the overlying serous (sign of the central point). Ultrasonography can be used in non-obese patients or in those who have contraindications to the tomography radiation [11] , [12] .…”

“…European and American societies suggest that if there is no palpable nodule, laparoscopic repair is preferable, always using a mesh. But in the end, the surgeon's experience should be the basis for the best choice [3] , [11] .…”

Spigelian Hernia

“…Spigelian hernias (SH) are defined as a protrusion of preperitoneal fat, peritoneum or an organ through a defect that can be acquired or congenital, located laterally to the rectus abdominis in the anterior abdominal wall [2,3]. This type of hernia is rare and has been estimated to account for <2% of all abdominal wall hernias [3][4][5][6][7][8][9][10].…”

“…Due to the high risk of incarceration (25%) [4,6,7], this type of hernia is indicated for surgery [4,5,7,9,11,12]. The surgery can be performed openly or laparoscopically, with or without mesh placement [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. Currently, the laparoscopic approach is increasingly used as it is associated with low morbidity rates [2-6, 8, 9, 13, 14].…”