Kara Donovan, BS, Merritt Denham, BS, Kristine Kuchta, MS, Joann Carbray, BS, Michael Ujiki, MD, John Linn, MD, Woody Denham, MD, Stephen Haggerty, MD. NorthShore University HealthSystem
Introduction: Spigelian hernias (SH) are rare intraparietal hernias occurring just medial to the semilunar line. They often involve older patients, are difficult to diagnose, and have a high risk for incarceration and strangulation. Historically repaired using open surgery, several small series have reported laparoscopic repair over the last two decades. Both totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) approaches have been described. However, there is limited outcome data including both of these approaches. We present the largest series to date of laparoscopic Spigelian hernia repair including both popular approaches.
Methods and Procedures: Consecutive patients (n=73) undergoing laparoscopic spigelian hernia repair from 2009-2018 were identified from a prospectively managed quality database. All procedures were performed at a single institution by one of four general surgeons. Patients were divided based on laparoscopic approach used, totally extraperitoneal (TEP) group (n=33) and a transabdominal preperitoneal (TAPP) group (n=40). A descriptive analysis of patient demographics, surgical characteristics, and post-operative complications was performed on both groups.
Results: In the TAPP cohort, 70% of patients were female and mean age was 65(±14) years. Median hernia size was 4.9 cm2 and mean operative time was 77(±44) minutes. 95% used tacks, with a mean of 9(±1) tacks. Median length of stay (LOS) was 25 hours. Five (12.5%) patients had an ED visit within 30 days of repair. One (2.5%) patient had a readmission, one had a reoperation, and one experienced a surgical site infection (SSI). One patient recurred, with a median follow-up of 957 days.
In the TEP cohort, 61% were male and mean age was 71(±12) years. Median hernia size was 3.1 cm2 and mean operative time was 48(±22) minutes. 79% used tacks, with a mean of 7(±3) tacks. Median LOS was 7 hours. One (3.0%) patient had an ED visit within 30 days of repair. There were no readmissions, reoperations, SSI, or recurrence, with a median follow-up of 259 days.
Conclusion: Our large series indicates both the TEP and TAPP approach to laparoscopic spigelian hernia repair are safe and effective, can be performed on an outpatient basis and should be favored over open surgery. The laparoscopic approach used should be based on surgeon experience and preference.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94626
Program Number: P601
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster