Laparoscopic Spigelian Hernia Repair: A Systematic Review

Background Rare locations of hernias, as well as primary ventral hernias under certain circumstances (cirrhosis, dialysis, rectus diastasis, subsequent pregnancy), might be technically challenging. The aim was to identify situations where the treatment strategy might deviate from routine management. Methods The guideline group consisted of surgeons from the European and Americas Hernia Societies. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used in formulating the recommendations. The Scottish Intercollegiate Guidelines Network (SIGN) critical appraisal checklists were used to evaluate the quality of full‐text papers. A systematic literature search was performed on 1 May 2018 and updated 1 February 2019. The Appraisal of Guidelines for Research and Evaluation (AGREE) instrument was followed. Results Literature was limited in quantity and quality. A majority of the recommendations were graded as weak, based on low quality of evidence. In patients with cirrhosis or on dialysis, a preperitoneal mesh repair is suggested. Subsequent pregnancy is a risk factor for recurrence. Repair should be postponed until after the last pregnancy. For patients with a concomitant rectus diastasis or those with a Spigelian or lumbar hernia, no recommendation could be made for treatment strategy owing to lack of evidence. Conclusion This is the first European and American guideline on the treatment of umbilical and epigastric hernias in patients with special conditions, including Spigelian and lumbar hernias. All recommendations were weak owing to a lack of evidence. Further studies are needed on patients with rectus diastasis, Spigelian and lumbar hernias.

show abstract

“…Literature is sparse, including only a limited number of patients. Three reviews, one RCT and one prospective case series were identified.…”

Section: Resultsmentioning

confidence: 99%

EHS and AHS guidelines for treatment of primary ventral hernias in rare locations or special circumstances

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Spigelian hernias can present as acute small bowel obstructions [15, 21] even of the colon [22]. Most Spigelian hernias present a localised hernia, or as local pain with or without a hernia sac [15–20].…”

Section: Resultsmentioning

confidence: 99%

“…Most Spigelian hernias present a localised hernia, or as local pain with or without a hernia sac [15–20]. Symptoms however can also be insidious and vague.…”

Section: Resultsmentioning

confidence: 99%

“…A recent systematic review of the laparoscopic repair of a Spigelian hernia [15] identified 55 articles and concluded that laparoscopic repair of the Spigelian hernia is a safe and acceptable method. Although intraperitoneal mesh technique is the most popular repair method, various techniques were used in these 237 repairs without a single randomised trial.…”

Section: Resultsmentioning

confidence: 99%

“…Most articles are case reports—the first publication in gynaecological literature was in 1992 [14]—or small series, the largest describing 40 cases [4]. Considering that five reviews were published since 11 January 2015 [15–20] and that articles before 1 January 2010 were almost exclusively case reports adding little to ethology, diagnosis or treatment, the review was limited to the last 6 years.…”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Spigelian hernia in gynaecology

Ussia¹,

Imperato²,

Schindler

et al. 2017

Gynecol Surg

View full text Add to dashboard Cite

BackgroundA Spigelian hernia is a rare hernia through the Spigelian fascia between the rectus muscle and the semilunar line. This hernia is well known in surgery. Symptoms vary from insidious to localised pain, an intermittent mass and/or a bowel obstruction.ResultsThe Spigelian hernia is poorly known in gynaecology. Spigelian hernias may be causally related to secondary trocar insertion. This review is written to increase awareness in gynaecology and is illustrated by a case report in which the diagnosis was missed for 4 years even by laparoscopy. Smaller hernias risk not to be diagnosed and will thus not be treated. Even larger Spigelian hernias might not be recognised and treated appropriately.ConclusionsThe gynaecologist should consider a Spigelian hernia in women with localised pain in the abdominal wall lateral of the rectus muscle some 5 cm below the umbilicus. Smaller hernias can be closed by laparoscopy without a mesh. Larger hernias require a mesh repair.

show abstract