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
Article

Abstract

Background

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.

Method

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.

Results

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).

Conclusion

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.

Keywords

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

Notes

Acknowledgments

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

Disclosures

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

References

  1. 1.
    Skandalakis P, Zoras O, Skandalakis JE, Mirilas P (2006) Spigelian hernia: surgical anatomy, embryology, and technique of repair. Am Surg 72:42–48PubMedGoogle Scholar
  2. 2.
    Mouton WG, Otten KT, Weiss D, Naef M, Wagner HF (2006) Preperitoneal mesh repair in Spigelian hernia. Int Surg 91:262–264PubMedGoogle Scholar
  3. 3.
    Campanelli G, Pettianari D, Nicolosi FM, Contesstini E (2005) Spigelian hernia. Hernia 9:3–5CrossRefPubMedGoogle Scholar
  4. 4.
    Moreno-Egea A, Carrasco L, Girela E, Martín JG, Aguayo JL, Canteras M (2002) Open vs laparoscopic repair of Spigelian hernias: a prospective randomized trial. Arch Surg 137:1266–1268CrossRefPubMedGoogle Scholar
  5. 5.
    Martell EG, Singh NN, Zagorski SM, Sawyer MA (2004) Laparoscopic repair of a Spigelian hernia: a case report and literature review. JSLS 8(3):269–274PubMedCentralPubMedGoogle Scholar
  6. 6.
    Mittal T, Kumar V, Khullar R, Sharma A, Soni V, Baijal M et al (2008) Diagnosis and management of Spigelian hernia: a review of literature and our experience. J Minim Access Surg 4(4):95–98CrossRefPubMedCentralPubMedGoogle Scholar
  7. 7.
    Zachariah SK, Jose P (2011) Laparoscopic diagnosis of incarcerated Spigelian hernia. Report of a case and review of the literature. Case Rep Surg 2011:491802. doi:10.1155/2011/491802 PubMedCentralPubMedGoogle Scholar
  8. 8.
    Nagarsheth KH, Nickloes T, Mancini G, Solla JA (2011) Laparoscopic repair of incidentally found Spigelian hernia. JSLS 15:81–85CrossRefPubMedCentralPubMedGoogle Scholar
  9. 9.
    Barker R, Gill RS, Brar AS, Birch DW, Karmali S (2013) Emergent laparoscopic repair of a Spigelian hernia: case report and review of the literature. Case Rep Med 2013:197561. doi:10.1155/2013/197561 PubMedCentralPubMedGoogle Scholar
  10. 10.
    Zacharakis E, Papadopoulos V, Ganidou M, Zacharakis E (2006) Incarcerated Spigelian hernia: a case report. Med Sci Monit 12(7):64–66Google Scholar
  11. 11.
    Light D, Chattopdhyay D, Bawa S (2013) Radiological and clinical examination in the diagnosis of Spigelian hernia. Ann R Coll Surg Engl 95:98–100CrossRefPubMedCentralPubMedGoogle Scholar
  12. 12.
    Zuvela M, Milicevic M, Galun D, Djuric-Stefanovic A, Bulajic P, Palibrk I (2013) Spigelian hernia repair as a day-case procedure. Hernia 17:483–486CrossRefPubMedGoogle Scholar
  13. 13.
    Larson DW, Farley DR (2002) Spigelian hernia: repair and outcome for 81 patients. World J Surg 26:1277–1281CrossRefPubMedGoogle Scholar
  14. 14.
    Tarnoff M, Rosen M, Brody F (2002) Planned totally extraperitoneal laparoscopic Spigelian hernia repair. Surg Endosc 16:358–363CrossRefGoogle Scholar
  15. 15.
    Iswariah H, Metcalfe M, Morrison CP, Maddern GJ (2003) Facilitation of open Spigelian hernia repair by laparoscopic location of the hernial defect. Surg Endosc 17:832CrossRefPubMedGoogle Scholar
  16. 16.
    Felix E, Michas C (1994) Laparoscopic repair of Spigelian hernias. Surg Laparosc Endosc 4:308–310PubMedGoogle Scholar
  17. 17.
    Strand L, Larsen J (2002) Laparoscopic surgery of Spigelian hernia. Ugeskr Laeger 164:1223–1224PubMedGoogle Scholar
  18. 18.
    Amendolara M (1998) Videolaparoscopic treatment of Spigelian hernias. Surg Laparosc Endosc 8:136–139CrossRefPubMedGoogle Scholar
  19. 19.
    DeMatteo RR, Morris JB, Broderick G (1994) Incidental laparoscopic repair of Spigelian hernia. Surgery 115:521–522PubMedGoogle Scholar
  20. 20.
    Kasirajan K, Lopez J, Lopez R (1997) Laparoscopic technique in the management of Spigelian hernia. J Laparoendosc Adv Surg Tech A 7(6):385–388CrossRefPubMedGoogle Scholar
  21. 21.
    Skouras C, Purkayastha S, Jiao L, Tekkis P, Darzi A, Eng H, Zacharakis E (2011) Laparoscopic management of Spigelian hernias. Surg Laparosc Endosc Percutan Tech 21:76–81CrossRefPubMedGoogle Scholar
  22. 22.
    Leff, Hassell J, Sufi P, Heath D (2009) Emergency and elective laparoscopic repair of Spigelian hernia. Two case reports and a review of the literature. Surg Laparosc Endosc Percutan Tech 19:el52–el55CrossRefGoogle Scholar
  23. 23.
    Bittner JG, Edwards MA, Shah MB, Macfadyen BV, Mellinger JD (2008) Mesh-free laparoscopic Spigelian hernia repair. Am Surg 74(8):713–720PubMedGoogle Scholar
  24. 24.
    Rath A, Bhatia P, Kalhan S, John S, Khetan M, Bindal V et al (2013) Laparoscopic management of Spigelian hernias. Asian J Endosc Surg 6:253–256CrossRefPubMedGoogle Scholar
  25. 25.
    Palanivelu C, Vijaykumar M, Jani KV, Rajan PS, Maheshkumaar GS, Rajapandian S (2006) Laparoscopic transabdominal preperitoneal repair of Spigelian hernia. JSLS 10:193–198PubMedCentralPubMedGoogle Scholar
  26. 26.
    Moreno-Egea A, Carrillo-Alcaraz A, Soria-Aledo V (2013) Randomized clinical trial of laparoscopic hernia repair comparing titanium-coated lightweight mesh and medium-weight composite mesh. Surg Endosc 27(1):231–239CrossRefPubMedGoogle Scholar
  27. 27.
    Barnes TG, McFaul C, Abdelrazeq AS (2014) Laparoscopic transabdominal preperitoneal repair of Spigelian hernia – closure of the fascial defect is not necessary. J Laparoendosc Adv Surg Tech 24(2):1–6CrossRefGoogle Scholar
  28. 28.
    Brill JB, Turner PL (2011) Long-term outcomes with transfascial sutures versus tacks in laparoscopic ventral hernia repair: a review. Am Surg 77(4):458–465PubMedGoogle Scholar
  29. 29.
    Moreno-Egea A (2014) The use of glue in hernia surgery. Combined fixation technique in laparoscopic hernia repair. Cir Esp 92(1):57–58CrossRefPubMedGoogle Scholar
  30. 30.
    Nguyen SQ, Divino CM, Buch KE, Schnur J, Weber KJ, Katz LB et al (2008) Postoperative pain after laparoscopic ventral hernia repair: a prospective comparison of sutures versus tacks. JSLS 12(2):113–116PubMedCentralPubMedGoogle Scholar

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

Personalised recommendations