Laparoscopic Treatment of Spiegel Hernia by Total Extraperitoneal (TEP) Approach

Background: Spiegelian hernia is a rare type of ventral abdominal hernia. Surgical treatment is recommended due to the high risk of complications. Laparoscopic treatment is preferred to open repair, by means of intraperitoneal or extraperitoneal mesh placement, either by transperitoneal (TAPP) or by total extraperitoneal (TEP) approach. Total extraperitoneal approach is rarely reported in the literature. Aim: To evaluate the results of laparoscopic repair of Spiegel hernia by total extraperitoneal approach. Material and Method: We prospectively studied the patients operated on for Spiegel hernia between October 2009 and March 2013 by laparoscopic TEP approach at Ponderas Hospital. Data regarding symptoms, sex, preoperative work-up, surgical technique, hospital stay and outcome of the procedure were analysed. Follow-up of the patients was achieved at 1 week, 1 month, 6 months and yearly postoperatively and patients were evaluated for recurrence, chronic pain, mesh infection, time to reinsertion to normal activities and overall patient satisfaction score. Results: We have treated 4 patients with Spiegel hernia by laparoscopic TEP repair, with mean age 55.25 years (range 50-64), sex ratio 1 (2/2); all patients were symptomatic, all cases had left sided hernias, the surgical intervention was elective in all cases. Mean hospital stay was 1.5 days (range 1-2 days). There was only one postoperative complication in a patient with asymptomatic seroma, with remission in 1 month. There were no recurrences, no mesh infection, no chronic pain or other morbidity at a mean follow-up of 25 months (range 12-53 months). The overall satisfaction score was maximal (5) in all cases. Conclusions: Spiegelian hernias are rare but surgery is mandatory because of the risk of complications like incarceration and strangulation. In the presented experience, laparoscopic total extraperitoneal approach proved to be an efficient technique, reproducible, with excellent results for Spiegel hernia treated electively.