Laparoscopic Treatment of Spiegel Hernia by Total Extraperitoneal (TEP) Approach
S. Filip, C. Dragomirescu, C. CopăescuOriginal article, no. 3, 2014
Background: Spiegelian hernia is a rare type of ventralabdominal hernia. Surgical treatment is recommended due tothe high risk of complications. Laparoscopic treatment ispreferred to open repair, by means of intraperitoneal orextraperitoneal mesh placement, either by transperitoneal(TAPP) or by total extraperitoneal (TEP) approach. Totalextraperitoneal approach is rarely reported in the literature.Aim: To evaluate the results of laparoscopic repair of Spiegelhernia by total extraperitoneal approach.Material and Method: We prospectively studied the patientsoperated on for Spiegel hernia between October 2009 and March 2013 by laparoscopic TEP approach at PonderasHospital. Data regarding symptoms, sex, preoperative work-up,surgical technique, hospital stay and outcome of the procedurewere analysed. Follow-up of the patients was achieved at 1week, 1 month, 6 months and yearly postoperatively andpatients were evaluated for recurrence, chronic pain, meshinfection, time to reinsertion to normal activities and overallpatient satisfaction score.Results: We have treated 4 patients with Spiegel hernia bylaparoscopic TEP repair, with mean age 55.25 years (range50-64), sex ratio 1 (2 2); all patients were symptomatic, allcases had left sided hernias, the surgical intervention waselective in all cases. Mean hospital stay was 1.5 days (range1- 2 days). There was only one postoperative complication ina patient with asymptomatic seroma, with remission in 1month. There were no recurrences, no mesh infection, nochronic pain or other morbidity at a mean follow-up of 25months (range 12-53 months). The overall satisfaction scorewas maximal (5) in all cases.Conclusions: Spiegelian hernias are rare but surgery is mandatorybecause of the risk of complications like incarceration andstrangulation. In the presented experience, laparoscopic totalextraperitoneal approach proved to be an efficient technique,reproducible, with excellent results for Spiegel hernia treatedelectively.
