A Systematic Review of the Evolution of Surgical Technique for Spigelian Hernia

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.