Transabdominal Preperitoneal (TAPP) for the Treatment of Spigelian hernias

Abstract

Background And Objectives: Spigelian hernias (SH) are a rare variant of abdominal wall defects that require prompt surgical intervention. With the advancement of abdominal wall surgery capabilities, there are several possible approaches of repairing SH. The aim of the study was to present our experience in performing laparoscopic or robotic transabdominal preperitoneal (TAPP) repairs of SH and discuss the advantages of TAPP in such hernias.Methods: Retrospective review of a prospectively maintained database of SH TAPP repairs between February 1, 2015 and February 29, 2020. Data included clinical details, size and location of fascial defect, presence of concomitant hernias, surgery duration, length of stay (LOS), mesh type, mesh size, and fixation method. Follow up visits at 1 month postoperative and telephone survey for pain assessment and subsequent hernia-related treatment.Results: During the study period 16 patients underwent TAPP SH repairs, 13 laparoscopically and 3 robotic. Seven (44%) patients had a concomitant inguinal hernia with 1 patient having bilateral inguinal defects. Mean surgery duration and mean LOS were 78 (range 41 -120) minutes & 1.6 (range 1 -3) days, respectively. Immediate postoperative complications included 2 seromas and 1 port-site hematoma. Mean telephone survey follow up was 17 months (range 3 -49). Mean visual analogue scale scores were significantly lower at follow-up compared to discharge (1.9 vs 0.5, P = 0.0015). Conclusion:Advantages of TAPP SH repair include low postoperative chronic pain, potential low wound complications, intra-abdominal visualization of hernia contents, and repairing of concomitant inguinal hernias simultaneously.

Technical considerations for laparoscopic transabdominal preperitoneal repair of concurrent Spigelian‐inguinal hernia complex: A case report and review of literature

“…Laparoscopic repair is increasingly popular with benefits of better cosmesis, fewer postoperative wound complications, better pain control, shorter hospital stays, and earlier return to activity. [1][2][3][4] Laparoscopy also allows visualization of SH, especially asymptomatic hernias not detected preoperatively, thus better approximation and repair. 3 There are three broad approaches to laparoscopic repair of SH: TAPP, intraperitoneal onlay method (IPOM), and totally extraperitoneal (TEP).…”

“…Surgical repair is the only effective treatment and is traditionally performed via the open technique. Laparoscopic repair is increasingly popular with benefits of better cosmesis, fewer postoperative wound complications, better pain control, shorter hospital stays, and earlier return to activity 1–4 . Laparoscopy also allows visualization of SH, especially asymptomatic hernias not detected preoperatively, thus better approximation and repair 3 .…”

“…In 2021, Rayman et al 1 described a series of 16 patients who underwent minimally invasive TAPP repair of SH: 44% of patients ( n = 7) had concomitant inguinal hernia diagnosed preoperatively on CT. Primary defect closure was achieved in 69% and all patients had mesh placed in the preperitoneal space. Mean defect area for SH was 4.5 cm and postoperative complication was low with Clavien‐Dindo Grade 1 complication rate of 19%.…”

“…Spigelian hernia (SH) is rare, although SH with concurrent inguinal hernia (IH) is not uncommon. 1 The hernia location makes laparoscopic repair difficult, and this is commonly repaired by the open method. We present a synchronous SH and IH complex through the same SH defect and highlight the safety and feasibility of laparoscopic transabdominal preperitoneal (TAPP) repair.…”

“…Spigelian hernia (SH) is rare, although SH with concurrent inguinal hernia (IH) is not uncommon 1 . The hernia location makes laparoscopic repair difficult, and this is commonly repaired by the open method.…”