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Updated: Jul 2, 2026
Application of a New Mesh Fixation Method in Laparoscopic Incisional Hernia Repair
Published on: December 23, 2022
Mesh-free laparoscopic spigelian hernia repair
James G Bittner1, Michael A Edwards, Malay B Shah
1Section of Gastrointestinal Surgery, Department of Surgery, Medical College of Georgia School of Medicine, Augusta, Georgia 30912, USA.
Abstract:
Varied Spigelian hernia mesh repair techniques have been described, although evidence suggests laparoscopy results in less morbidity and shorter hospitalization compared with open procedures. Laparoscopic suture repair of Spigelian hernias is rarely reported. Two patients with small Spigelian hernias (< or =2 cm) were diagnosed and repaired laparoscopically using a transabdominal suture technique. Under laparoscopic guidance, a suture-passer was used to place two or three transfacial, interrupted 0 polypropylene sutures along the horizontal plane of the defect. Sutures were tied extracorporeally and closure was confirmed laparoscopically. These cases spurred a review of world literature (2001-2007) including clinical characteristics, operative techniques, and urgency of operations in Spigelian hernia patients. Data were compared using Fisher's exact test. One year postoperatively, the patients are without sequelae or recurrence. Literature review demonstrated most patients were females (P < 0.001), ranged in age from 60 to 80 years (P = 0.042), and presented with left-sided hernias (P = 0.026). Open mesh repair (182/392 cases; 47%) was the most common technique; however, increasingly articles describe laparoscopic mesh repair. Mesh-free laparoscopic suture repair is feasible and safe. This novel uncomplicated approach to small Spigelian hernias combines the benefits of laparoscopic localization, reduction, and closure without the morbidity and cost associated with foreign material.
Insights
Laparoscopic suture repair is a safe and effective mesh-free technique for small Spigelian hernias. This approach offers benefits of laparoscopic surgery without foreign material complications.
Area of Science:
- General Surgery
- Minimally Invasive Surgery
Background:
- Spigelian hernias are uncommon abdominal wall defects.
- Laparoscopic repair is associated with less morbidity and shorter hospitalization than open repair.
- Laparoscopic suture repair for Spigelian hernias is rarely documented.
Observation:
- Two patients with small Spigelian hernias (< or =2 cm) underwent successful laparoscopic transabdominal suture repair.
- The technique involved laparoscopic guidance for placing interrupted polypropylene sutures.
- Postoperative follow-up showed no sequelae or recurrence at one year.
Findings:
- Literature review (2001-2007) indicated Spigelian hernias predominantly affect females, aged 60-80, and are often left-sided.
- Open mesh repair was most common, but laparoscopic mesh repair is increasing.
- Mesh-free laparoscopic suture repair is a feasible and safe alternative.
Implications:
- This technique offers a novel, uncomplicated approach for small Spigelian hernias.
- It combines laparoscopic advantages with avoidance of foreign material morbidity and cost.
- This method presents a viable alternative to mesh repair in select cases.
