Surgical Endoscopy

, Volume 29, Issue 4, pp 856–862 | Cite as

Which should be the gold standard laparoscopic technique for handling Spigelian hernias?

  • Alfredo Moreno-Egea
  • Álvaro Campillo-Soto
  • German Morales-Cuenca



The advantages and disadvantages of both extraperitoneal and intra-abdominal laparoscopic Spigelian hernia repair are still being discussed. To our knowledge, no study has compared both techniques in terms of safety, feasibility, and cost-effectiveness.


Prospective data were collected to compare the results of the extraperitoneal approach with the intra-abdominal approach in laparoscopic Spigelian hernia repair, between 2000 and 2012 (n = 16). Diagnosis was confirmed preoperatively by ultrasonography and/or tomography.


Spigelian hernias occur mostly in women (69 %), on the left side (56 %) and at a median age of 62 (range: 38–83). In our study, the extraperitoneal technique was performed in seven patients, while the intra-abdominal approach was indicated in nine. No complications, re-admissions, or recurrences were detected in either during a mean follow-up of 48 months (range: 18 months–9 years). The statistical study showed that there was no difference in either morbidity or the recurrence rate between a totally extraperitoneal (TEP) and an intraperitoneal onlay mesh (IPOM) repair. The mean duration of an IPOM repair was, though, shorter than that of a TEP repair (30 vs. 48 min, P = 0.06). The combined fixation technique (tacks + glue) did not modify the results but did reduce the costs, as shown in the cost-effectiveness study where the intra-abdominal approach was cheaper (1260 vs. 2200 euros, P < 0.001).


Laparoscopy seems to be a safe and feasible technique whichever the approach chosen, be it intra or extraperitoneal. Our experience shows that intra-abdominal laparoscopic Spigelian hernia repair should be recommended as the gold standard because of its technical and economic advantages. The IPOM procedure with a lightweight titanium-coated mesh fixed using a combined technique is a highly effective option for Spigelian hernia repair.


Spigelian hernia Laparoscopic repair Lightweight mesh Synthetic tissue adhesive Extraperitoneal repair Intra-abdominal repair 



The authors thank an all consultant and resident surgeons what referring their patients to us to undergo laparoscopic repair.


Drs. Alfredo Moreno-Egea, German Morales-Cuenca, and Alvaro Campillo-Soto have no conflicts of interest or financial ties to disclose.


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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Alfredo Moreno-Egea
    • 1
  • Álvaro Campillo-Soto
    • 1
  • German Morales-Cuenca
    • 1
  1. 1.Abdominal Wall Unit, Department of SurgeryMorales Meseguer University HospitalMurciaSpain

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