Laparoscopic Approaches to Spigelian Hernia Repair
Summary
Spigelian hernias arise through a defect in the semilunar line of the anterior abdominal wall and account for a small proportion of ventral hernias. The advent of laparoscopic repair has transformed management by offering minimal access, precise visualisation and reduced postoperative morbidity. Key techniques include intraperitoneal onlay mesh (IPOM), in which a prosthetic mesh is fixed against the peritoneum; transabdominal preperitoneal (TAPP) repair, where the mesh is placed in a preperitoneal plane after peritoneal incision; and total extraperitoneal (TEP) repair, avoiding peritoneal entry entirely. More recently, robotic ventral transabdominal preperitoneal repair has been introduced to enhance dexterity and three-dimensional vision. Across these approaches, elective intervention is advised to prevent incarceration and strangulation, and mesh reinforcement is generally preferred to suture closure alone. Comparative studies indicate that laparoscopic repair achieves shorter hospital stays, faster return to normal activity and low recurrence rates. Challenges remain in case selection, mesh fixation and cost-effectiveness, but ongoing innovation in mesh design and instrumentation continues to refine outcomes. Laparoscopic techniques are increasingly adopted worldwide as standard practice for Spigelian hernia repair, with applicability in both elective and emergency settings.
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Laparoscopic Approaches to Spigelian Hernia Repair publication trend
The graph below shows the total number of articles in laparoscopic approaches to spigelian hernia repair across all publications each year (not limited to Nature Index journals).
Technical terms
Spigelian hernia: A protrusion of abdominal contents through a defect in the semilunar line of the anterior abdominal wall.
Intraperitoneal onlay mesh (IPOM): A laparoscopic technique in which mesh is deployed on the inner surface of the peritoneum and fixed to the abdominal wall.
Transabdominal preperitoneal (TAPP) repair: A method involving entry into the peritoneal cavity to place mesh in the preperitoneal space beneath the abdominal muscles.
Total extraperitoneal (TEP) repair: A minimally invasive approach that creates a working space in the preperitoneal plane without breaching the peritoneal cavity.
Strangulation: Compromise of blood supply to herniated tissue, risking ischaemia and requiring urgent surgical intervention.
References
- Spigelian hernia: current approaches to surgical treatment—a review. Hernia (2021).
- Spigelian hernia: a multi-site review of operative outcomes of surgical repair in the adult population. Hernia (2024).
- Non-strangulated Spigelian Hernia: A Case Report. Cureus (2022).
- Robotic Ventral Transabdominal Preperitoneal Repair of Uncomplicated Spigelian Hernia. Cureus (2023).
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