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Laparoscopic totally extraperitoneal and transabdominal preperitoneal approaches are equally effective for spigelian hernia repair

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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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References

  1. Skandalakis PN, Zoras O, Skandalakis JE, Mirilas P (2006) Spigelian hernia: surgical anatomy, embryology, and technique of repair. Am Surg 72:42–48

    Article  Google Scholar 

  2. Campanelli G, Pettinari D, Nicolosi FM, Avesani EC (2005) Spigelian hernia. Hernia 9:3–5

    Article  CAS  Google Scholar 

  3. Webber V, Low C, Skipworth RJE, Kumar S, de Beaux AC, Tulloh B (2017) Contemporary thoughts on the management of Spigelian hernia. Hernia 21:355–361

    Article  CAS  Google Scholar 

  4. Carter JE, Mizes C (1992) Laparoscopic diagnosis and repair of Spigelian hernia: Report of a case and technique. Am J Obstet Gynecol 167:77–78

    Article  CAS  Google Scholar 

  5. Moreno-Egea A, Carrasco L, Girela E, Martín JG, Aguayo JL, Canteras M (2002) Open vs laparoscopic repair of spigelian hernia: a prospective randomized trial. Arch surg 137:1266–1268

    Article  Google Scholar 

  6. Moreno-Egea A, Aguayo JL, Girela E (2002) Treatment of spigelian hernia using totally extraperitoneal laparoscopy ambulatory surgery. Surg Endosc 16:1806

    Article  CAS  Google Scholar 

  7. Palanivelu C, Vijaykumar M, Jani KV, Rajan PS, Maheshkumaar GS, Rajapandian S (2006) Laparoscopic transabdominal preperitoneal repair of spigelian hernia. JSLS 10:193–198

    PubMed  PubMed Central  Google Scholar 

  8. Kelly ME, Courtney D, McDermott FD, Heeney A, Maguire D, Geoghegan JG, Winter DC (2015) Laparoscopic spigelian hernia repair: a series of 40 patients. Surg Laparosc Endosc Percutan Tech 25:e86–e89

    Article  Google Scholar 

  9. Chan JW, Chiu PW, Ng EK (2008) Simultaneous laparoscopic totally extraperitoneal repair for concurrent ipsilateral Spigelian and indirect inguinal hernia. Surg Laparosc Endosc Percutan Tech 18:414–416

    Article  Google Scholar 

  10. Law TT, Ng KK, Ng L, Wong KY (2018) Elective laparoscopic totally extraperitoneal repair for Spigelian hernia: a case series of four patients. Asian J Endosc Surg 11:244–247

    Article  Google Scholar 

  11. Moreno-Egea A, Flores B, Girela E, Martín JG, Aguayo JL, Canteras M (2002) Spigelian hernia: bibliographical study and presentation of a series of 28 patients. Hernia 6:167–170

    Article  CAS  Google Scholar 

  12. Fernandez-Moreno M, Marti-Cunat E, Pou G, Ortega J (2018) Intraperitoneal onlay mesh technique for Spigelian hernia in an outpatient and short-stay surgery unit: What's new in intraperitoneal meshes? J Lap Adv Surg Tech 28(6):700–704

    Article  Google Scholar 

  13. Mittal T, Kumar V, Khullar R, Sharma A, Soni V, Baijal M, Chowbey PK (2008) Diagnosis and management of spigelian hernia: a review of literature and our experience. J Minim Access Surg 4:95–98

    Article  CAS  Google Scholar 

  14. 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 A 24:66–71

    Article  Google Scholar 

  15. Patle NM, Tantia O, Sasmal PK, Khanna S, Sen B (2010) Laparoscopic repair of Spigelian hernia: our experience. J Laparoendosc Adv Surg Tech A 20:129–133

    Article  Google Scholar 

  16. Moreno-Egea A, Campillo-Soto Á, Morales-Cuenca G (2015) Which should be the gold standard laparoscopic technique for handling Spigelian hernias? Surg Endosc 29:856–862

    Article  Google Scholar 

  17. Barnes T, McWhinne D (2016) Laparoscopic Spigelian Hernia Repair: A Systematic Review. Surg Laparosc Endosc Percutan Tech 26:265–270

    Article  Google Scholar 

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Acknowledgements

The authors would like to acknowledge the Grainger Foundation for salary support for a portion of the data collection.

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  1. NorthShore University HealthSystem, 2650 Ridge Ave., Evanston, IL, 60201, USA

    Kara Donovan, Merritt Denham, Kristine Kuchta, JoAnn Carbray, Michael Ujiki, John Linn, Woody Denham & Stephen Haggerty

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  1. Kara Donovan
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  2. Merritt Denham
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  3. Kristine Kuchta
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Correspondence to Stephen Haggerty.

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Disclosure

Dr. Michael Ujiki reports grants and personal fees from Boston Scientific, personal fees from Olympus, personal fees from Medtronic, grants and personal fees from Gore, outside the submitted work. Dr. John Linn reports teaching honoraria from R.L Gore and Dr. Stephen Haggerty reports personal fees from Medtronic, personal fees from RL Gore, travel expense from Intuitive, outside the submitted work.The authors Kara Donovan, Merritt Denham, Kristine Kuchta, JoAnn Carbray, and Dr. Woody Denham have no conflicts of interests or financial ties to disclose.

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Donovan, K., Denham, M., Kuchta, K. et al. Laparoscopic totally extraperitoneal and transabdominal preperitoneal approaches are equally effective for spigelian hernia repair. Surg Endosc 35, 1827–1833 (2021). https://doi.org/10.1007/s00464-020-07582-9

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  • DOI: https://doi.org/10.1007/s00464-020-07582-9

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