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

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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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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.

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Authors and Affiliations

  1. Abdominal Wall Unit, Department of Surgery, Morales Meseguer University Hospital, Avda Primo de Rivera 7, 5ºD, 3008, Murcia, Spain

    Alfredo Moreno-Egea, Álvaro Campillo-Soto & German Morales-Cuenca

Authors
  1. Alfredo Moreno-Egea
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  2. Álvaro Campillo-Soto
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  3. German Morales-Cuenca
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Correspondence to Alfredo Moreno-Egea.

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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 29, 856–862 (2015). https://doi.org/10.1007/s00464-014-3738-9

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  • DOI: https://doi.org/10.1007/s00464-014-3738-9

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