Transabdominal Preperitoneal Approach in Spigelian Hernia: An Effective and Modern Surgical Technique

Abstract

Introduction:

Spigelian hernia is a rare intraparietal abdominal wall hernia that occurs just medial to the semilunar line. It accounts for only 0.1%–2% of all ventral hernias. ¹ Traditionally, Spigelian hernias have been repaired using an open approach with a primary suture repair, or by placing an onlay or sublay mesh. The first case of laparoscopic repair was reported by Carter and Mizes in 1992. ² While there is no gold standard technique for its repair transabdominal preperitoneal (TAPP) offers various advantages compared with other techniques that we have explored in this case presentation. ^3,4

Material & Methods:

A 62-year-old female presented with a 1-year history of swelling in the left lower abdomen, associated with mild, dull aching pain. The swelling increased on coughing and reduced in the supine position. Examination revealed a 2 × 2 cm reducible swelling in the left lower abdominal quadrant with a cough impulse and no evidence of other hernias. CECT abdomen confirmed a Spigelian hernia with omental content. Laparoscopic TAPP repair was performed, revealing an additional occult inguinal hernia. A large mesh was placed to cover both defects.

Results:

Postoperative recovery followed ERAS protocols, with low VAS pain scores. The patient was discharged on POD 2 and remained asymptomatic at the 2-week follow-up.

Conclusion:

The lower risk of mesh-related complications, excellent postoperative pain control, and the advantage of visualizing and repairing concomitant intra-abdominal hernias, such as occult inguinal hernias, make TAPP an attractive and feasible procedure for repair of Spigelian hernia.

Patient consent statement:

The corresponding author has received and archived patient consent for video recording/publication of the video without exhibiting patient demographic details in advance.

Source of work or study:

This is an original work carried out in a tertiary care public hospital, and there are no conflicts of interest or obligations resulting from it to any of the authors.

There have been commercial associations during the last 3 years that might create a conflict of interest in connection with the video.

Run time of video:

9 mins 11 secs.