A Systematic Review of the Evolution of Surgical Technique for Spigelian Hernia
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REVIEW ARTICLE
A Systematic Review of the Evolution of Surgical Technique for Spigelian Hernia Mayank Roy 1
&
Vickna Balarajah 2 & Satvinder Mudan 2
Received: 14 May 2020 / Accepted: 15 August 2020 # Association of Surgeons of India 2020
Abstract The operative technique for Spigelian hernia (SH) continues to evolve over the last few decades. The primary endpoint of this systematic review was to evaluate the evolution of surgical technique for the management of SH in adults, and to identify the optimum technique for easy identification of anatomical landmarks. The secondary outcome was to evaluate the operative management of bilateral SH. A systematic search using Cochrane, Medline, and Google Scholar databases was performed to identify all studies from 1989 to 2019 investigating the management of SH. Of 535 articles identified, 29 studies reporting on 619 patients (389 open repair and 230 laparoscopic repair) were included, out of which 25 studies (469 patients) described complication and recurrence rate. Five additional studies reporting on five patients with bilateral SH were identified for a total of 19 cases (3.1%) of bilateral SH. There has been a gradual transition from open to laparoscopic SH repair over the last three decades. Overall complication and recurrence rates after SH repair were 5.5% and 2.8% respectively, with higher rates in open repair (complication 7.7% and recurrence 4.2%). The laparoscopic transabdominal preperitoneal repair (TAPP) has the lowest recurrence and complication rate reported in the literature. The choice of SH repair should be based on the need for abdominal wall reconstruction, any associated intra-abdominal pathology, and the experience of the surgeon. Laparoscopic TAPP with mesh appears to have the lowest complication and recurrence rate. Keywords Spigelian hernia . Bilateral Spigelian hernia . Operative technique . Laparoscopic repair
Introduction Spigelian hernia (SH) is named after a Flemish Anatomist Adrian van der Spiegel, who first described the linea semilunaris in the seventeenth century [1]. SH is a type of ventral hernia, described as a protrusion of any intraabdominal contents through the abdominal wall along the semilunar line, particularly at the junction of the semilunar and the arcuate line. The clinical implications of a hernia at this location were described by Josef Klinkosch, who coined the term Spigelian hernia [2]. SH tends to present in the fourth to seventh decade
* Mayank Roy [email protected] 1
Department of General Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL 33331, USA
2
Department of Surgery, The London Clinic, 20 Devonshire Place, London W1G 6BW, UK
of a patient’s life. Increased intra-abdominal pressure (obesity, pregnancy, and chronic cough or lifting) and an overall weakness in the abdominal wall predispose patients to SH [3]. SH accounts for less than 1% of all abdominal hernias, and approximately 2% of all ventral hernias [4–6]. Bilateral SH remains rare and accounts for less than 3% of all SH [7].
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