Spigelian hernias in the adult population: a systematic review of the literature

Spigelian Hernia (SH) is characterized by the protrusion of abdominal viscera or preperitoneal fat through a defect in the spigelian aponeurosis. The objective of this systematic review was to evaluate current literature on Spigelian Hernias in adult population and elucidate their characteristics and preferable management.

MEDLINE and Scopus bibliographical databases were systematically searched (last search: 31st January 2024) for studies concerning SHs.

Two hundred and thirty-four articles met predefined inclusion criteria and concerned collectively 1,629 patients with SHs (58.7% females) with an age of 62.32 ± 17.71 (mean ± SD) years and a BMI of 28.56 ± 7.34 (mean ± SD) kg/m2. A minimally invasive approach was opted at 46.8% of cases, while a mesh was implemented at 67.9% of cases. Postoperative length of hospital stay was 2.8 ± 2.9 (mean ± SD) days. Following individual cases analysis, open surgery was preferable at emergency setting (OR: 2.45; 95% CI: 1.36–4.41; p-value: 0.003), and minimally invasive approaches were associated with shorter length of hospital stay [2 (1–9) vs. 5 (1–22) days; p-value: <0.001]. Overall, thirty-day postoperative morbidity and mortality rates reached 7.0% and 0.3% respectively.

SH is a rare ventral hernia, and it concerns most frequently overweight women. Open surgical approach is preferred in emergency cases, while laparoscopic surgery is associated with shorter hospitalization. Further comparative studies are necessary to determine optimal surgical approach.