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Zanatta M, Brancato G, Marano F, Donati M. Day Surgery for Spigelian Hernia Repair Under Local Anesthesia: A “Real Minimally Invasive” Surgical Approach. Indian J Surg 2024; 86:408-413. [DOI: 10.1007/s12262-023-03872-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 07/15/2023] [Indexed: 02/20/2025] Open
Abstract
AbstractSpigelian hernia (SH) represents less than 1% of all hernias and about 0,1% of abdominal wall hernias. Although it is a very rare hernia, it has a considerably high risk of strangulation. The aim of this work is to propose the open approach based on local anesthesia on a Day Surgery regimen as a safe treatment for Spigelian Hernia surgery. We report a series of 17 clinical cases (9 men and 8 women, between 40 and 80 years old) who underwent SH open repair on a Day Surgery basis between 2004 and 2021 in our University Hospital. In our single-center case series, no early postoperative complications occurred, except for a bulky seroma of about 800 cc. No prosthesis or surgical wound infections occurred and no recurrences were observed in the early postoperative period. Looking at our experience and the literature, Spigelian hernia repair under local anesthesia on a Day Surgery regimen, using a pre-peritoneal polypropylene mesh, could be proposed as a safe and “real minimally invasive” approach in elective settings.
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GUMUS S, DALCI K. Laparoscopy versus open surgery in treatment of Spigelian hernias. Chirurgia (Bucur) 2021. [DOI: 10.23736/s0394-9508.20.05157-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Cui TYS, Law TT, Ng L, Wong KY. Spigelian hernia: Our total extraperitoneal approach and a systematic review of the literature. Asian J Endosc Surg 2021; 14:529-539. [PMID: 33393194 DOI: 10.1111/ases.12912] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 12/07/2020] [Indexed: 01/27/2023]
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.
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Affiliation(s)
| | - Tsz Ting Law
- Department of Surgery, Tung Wah Hospital, Hong Kong
| | - Lily Ng
- Department of Surgery, Tung Wah Hospital, Hong Kong
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Valenzuela Alpuche H. Laparoscopic transabdominal preperitoneal repair in the management of Spiegelian hernia – A three-patient case series and review of the literature. INTERNATIONAL JOURNAL OF ABDOMINAL WALL AND HERNIA SURGERY 2021. [DOI: 10.4103/ijawhs.ijawhs_29_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Donovan K, Denham M, Kuchta K, Carbray J, Ujiki M, Linn J, Denham W, Haggerty S. Laparoscopic totally extraperitoneal and transabdominal preperitoneal approaches are equally effective for spigelian hernia repair. Surg Endosc 2020; 35:1827-1833. [PMID: 32333157 DOI: 10.1007/s00464-020-07582-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 04/18/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Spigelian hernias (SH) are rare intraparietal abdominal wall hernias occurring just medial to the semilunar line. Several small series have reported on laparoscopic SH repair and both totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) approaches have been described. However, there are limited outcome data including both of these techniques. We present the largest series to date of laparoscopic SH repair comparing both popular approaches. METHODS Consecutive patients (n = 77) undergoing laparoscopic SH repair from 2009 to 2019 were identified from a prospectively managed quality database. All procedures were performed at a single institution. Patients were divided based on laparoscopic approach used, TEP group (n = 37) and TAPP group (n = 40). Comparison of patient demographics, surgical characteristics, and post-operative complications between TAPP and TEP groups was made using the Wilcoxon rank-sum and Fisher's exact tests. RESULTS Individuals undergoing TAPP had higher mean BMI (29.3 ± 5.4 vs. 26.3 ± 5.6 kg/m2; p = 0.019) and were more likely to have had prior abdominal surgery (65% vs 24.3%, (p < 0.001). Mean procedure length was 77 ± 45 min for TAPP repairs and 48 ± 21 for TEP repairs (p = 0.001). TAPP repairs had a significantly longer median LOS than TEP (25 vs. 7 h; p < 0.001). Days of narcotic use were significantly shorter after TEP repair than for TAPP (0 vs. 3; p = 0.007) and return to ADL was significantly shorter after TEP repair than for TAPP (5 vs. 7 days; p = 0.016. There were no significant differences in readmission, reoperations, SSI, or recurrence between the two groups. CONCLUSION Our large series revealed that both preperitoneal laparoscopic approaches, TEP, and TAPP, for SH repair are equally safe, effective, and can be performed on an outpatient basis. Therefore, we suggest that the approach used for repair should be based on surgeon experience, preference, and individual patient factors.
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Affiliation(s)
- Kara Donovan
- NorthShore University HealthSystem, 2650 Ridge Ave., Evanston, IL, 60201, USA
| | - Merritt Denham
- NorthShore University HealthSystem, 2650 Ridge Ave., Evanston, IL, 60201, USA
| | - Kristine Kuchta
- NorthShore University HealthSystem, 2650 Ridge Ave., Evanston, IL, 60201, USA
| | - JoAnn Carbray
- NorthShore University HealthSystem, 2650 Ridge Ave., Evanston, IL, 60201, USA
| | - Michael Ujiki
- NorthShore University HealthSystem, 2650 Ridge Ave., Evanston, IL, 60201, USA
| | - John Linn
- NorthShore University HealthSystem, 2650 Ridge Ave., Evanston, IL, 60201, USA
| | - Woody Denham
- NorthShore University HealthSystem, 2650 Ridge Ave., Evanston, IL, 60201, USA
| | - Stephen Haggerty
- NorthShore University HealthSystem, 2650 Ridge Ave., Evanston, IL, 60201, USA.
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Karadimos D, Ip JCY. Laparoscopic mesh repair of an incarcerated Spigelian hernia causing small bowel obstruction. ANZ J Surg 2019; 90:E24-E25. [DOI: 10.1111/ans.15094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 01/07/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Darren Karadimos
- Acute Surgical Unit, Department of General SurgeryFiona Stanley Hospital Perth Western Australia Australia
| | - Julian C. Y. Ip
- Colorectal Surgical Unit, Department of General SurgeryFiona Stanley Hospital Perth Western Australia Australia
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Rankin A, Kostusiak M, Sokker A. Spigelian Hernia: Case Series and Review of the Literature. Visc Med 2018; 35:133-136. [PMID: 31192247 DOI: 10.1159/000494280] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background Spigelian hernia (SH) is an uncommon ventral abdominal hernia. Traditionally repaired with an open technique, the laparoscopic approach is becoming more common and widely described in the literature. We hold that the transabdominal preperitoneal (TAPP) approach restores the anatomy and prevents complications such as seroma. We present a series of SH repair carried out at a single district general hospital over the past 13 years and a review of the literature. Methods A retrospective case note review identified SH repaired between January 2005 and March 2018 at The Queen Elizabeth Hospital, King's Lynn, Norfolk, UK. A Medline search for 'Spigelian hernia' and 'laparoscopic' revealed 41 papers for review. Results 33 patients underwent repair of SH. We found that the TAPP repair with a mesh is anatomically the most sound repair, with all the added benefits of keyhole surgery, i.e. reduced hospital stay, quicker recovery, and fewer infections. Our complication rates matched those described in the literature. Conclusions Several operative techniques have been described to repair SH. We favour the laparoscopic TAPP approach which is safe, aids in confirming the correct diagnosis, and has all the benefits of keyhole surgery.
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Affiliation(s)
- Adeline Rankin
- Department of General Surgery, The Queen Elizabeth Hospital King's Lynn NHS Trust, King's Lynn, Norfolk, UK
| | - Milo Kostusiak
- Department of General Surgery, The Queen Elizabeth Hospital King's Lynn NHS Trust, King's Lynn, Norfolk, UK
| | - Ashraf Sokker
- Department of General Surgery, The Queen Elizabeth Hospital King's Lynn NHS Trust, King's Lynn, Norfolk, UK
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Law TT, Ng KK, Ng L, Wong KY. Elective laparoscopic totally extraperitoneal repair for Spigelian hernia: A case series of four patients. Asian J Endosc Surg 2018; 11:244-247. [PMID: 29297987 DOI: 10.1111/ases.12454] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 11/09/2017] [Accepted: 11/28/2017] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Spigelian hernia (SH) is uncommon. Clinical diagnosis may be difficult, but computed tomography (CT) can help to establish the diagnosis. Laparoscopic repair is increasingly performed because it is associated with low morbidity rates. Laparoscopic approaches include transabdominal preperitoneal (TAPP), intraperitoneal onlay mesh (IPOM), and totally extraperitoneal (TEP). Here, we report our experiences of TEP repair for SH. METHODS A retrospective review was performed on all patients with SH who underwent elective laparoscopic TEP repair from 2007 to 2017 at Tung Wah Hospital, Hong Kong. RESULTS Four patients with SH were identified in the study period: three with a preoperative diagnosis of SH confirmed by CT scan and one diagnosed incidentally during TEP repair for inguinal hernia. The patients' mean age was 66.8 years (range, 55.0-82.0 years). The mean BMI was 22.8 kg/m2 (range, 20.8-23.6 kg/m2 ). The mean size of the SH defect was 2.0 cm (range, 0.5-3.0 cm). The mean operative time was 59 min (range, 40-86 min). Concomitant direct inguinal hernia was found in one patient and repaired simultaneously. All patients were discharged on postoperative day 1. One patient developed seroma, which subsided on conservative management. At a mean follow-up of 36 months (range, 2-108 months), there was no recurrence. CONCLUSION Laparoscopic repair for SH is preferred over the open approach as it is associated with a low morbidity rate and a short hospital stay. In our experience, TEP technique is safe and effective in laparoscopic SH repair.
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Affiliation(s)
- Tsz Ting Law
- Department of Surgery, Tung Wah Hospital, Hong Kong
| | - Ka Kin Ng
- Department of Surgery, Tung Wah Hospital, Hong Kong
| | - Lily Ng
- Department of Surgery, Tung Wah Hospital, Hong Kong
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Fernández-Moreno MC, Martí-Cuñat E, Pou G, Ortega J. Intraperitoneal Onlay Mesh Technique for Spigelian Hernia in an Outpatient and Short-Stay Surgery Unit: What’s New in Intraperitoneal Meshes? J Laparoendosc Adv Surg Tech A 2018; 28:700-704. [DOI: 10.1089/lap.2017.0319] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
| | | | - Guillermo Pou
- Department of Surgery, Clinic University Hospital, Valencia, Spain
| | - Joaquín Ortega
- Department of Surgery, Clinic University Hospital, Valencia, Spain
- Department of Surgery, University of Valencia, Valencia, Spain
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Abstract
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.
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Afshari A, Nguyen L, Hermiz SJ, Chaipis PN. Management of Bilateral Spigelian Hernias. Am Surg 2016. [DOI: 10.1177/000313481608200701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ashkan Afshari
- Department of General Surgery, University of South Carolina School of Medicine, Columbia, South Carolina
| | - Lyly Nguyen
- Department of General Surgery, Morristown Medical Center, Morristown, New Jersey
| | - Steven J. Hermiz
- Department of General Surgery, University of South Carolina School of Medicine, Columbia, South Carolina
| | - Philip N. Chaipis
- Department of General Surgery, University of South Carolina School of Medicine, and Department of General Surgery, Dorn VA Medical Center, Columbia, South Carolina
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Affiliation(s)
- Mead Ferris
- Department of Surgery University of South Carolina School of Medicine Columbia, South Carolina
| | - Paul Diegidio
- Department of Surgery University of South Carolina School of Medicine Columbia, South Carolina
| | - Catherine Loflin
- Department of Surgery University of South Carolina School of Medicine Columbia, South Carolina
| | - James Nottingham
- Department of Surgery University of South Carolina School of Medicine Columbia, South Carolina
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Connor C, Pullatt R. Laparoscopic Transabdominal Preperitoneal Repair of an Incarcerated Spigelian Hernia. Am Surg 2014. [DOI: 10.1177/000313481408000905] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Chelsea Connor
- Department of Surgery Medical University of South Carolina Charleston, South Carolina
| | - Rana Pullatt
- Department of Surgery Medical University of South Carolina Charleston, South Carolina
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Moreno-Egea A, Campillo-Soto Á, Morales-Cuenca G. Which should be the gold standard laparoscopic technique for handling Spigelian hernias? Surg Endosc 2014; 29:856-62. [PMID: 25060686 DOI: 10.1007/s00464-014-3738-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 07/08/2014] [Indexed: 10/25/2022]
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.
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Affiliation(s)
- Alfredo Moreno-Egea
- Abdominal Wall Unit, Department of Surgery, Morales Meseguer University Hospital, Avda Primo de Rivera 7, 5ºD, 3008, Murcia, Spain,
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