Laparoscopic Tapp Repair of Spigelian and Bilateral Inguinal Hernia

Abstract Introduction A Spigelian hernia is the protrusion of preperitoneal fat, peritoneal sac, or organ(s) through a congenital or acquired defect in the Spigelian aponeurosis as defined in the last EHS guidelines for hernias in rare locations. Due to limited data no recommendation on the preferred approach could be made. We will report a case with a spigelian and bilateral inguinal hernia to show our preferred method of repair. Case presentation A 65-year-old male presented with a symptomatic palpable mass in the left lateral abdominal wall and bilateral inguinal hernia. We diagnosed by abdominal CT a Spigelian hernia along with bilateral direct inguinal hernias. A laparoscopic transabdominal approach was decided to manage all three hernias. Results Laparoscopic transabdominal approach confirmed the clinical and radiological diagnosis. The bilateral inguinal hernias were MW3-P and were repaired with invagination of the transversalis fascia into Cooper’s ligament and placement of XL 3D polypropylene mesh that was fixed in 3 points with absorbable tuckers. The Spigelian hernia was repaired by TAPP, closure of the 4 cm orifice with V-loc 1–0 and placement of a 12 × 16 cm self-gripping mesh to avoid postoperative pain due to fixation. Conclusion The use of laparoscopy facilitates low wound complication rate, complete intra-abdominal visualisation, repair of multiple hernia sites and probably less postoperative pain if no intrusive fixating devices are utilised. On the contrary open repair needs a wide operative field to introduce the mesh resulting in more postoperative pain, possibly increased wound complication rate and lacks the chance of simultaneous repair of concomitant inguinal hernias through the same approach.