Laparoscopic transabdominal preperitoneal repair of Spigelian hernia in a single-center case series

Spigelian hernia (SpH) is an uncommon abdominal wall defect characterized by protrusion of preperitoneal fat or a peritoneal sac through Spigelian’s aponeurosis. Most cases occur within the “Spigelian hernial belt,” between the umbilicus and the interspinal line. Diagnosis is challenging, often requiring imaging, and surgical repair remains the treatment of choice. Observational, retrospective single-center case series conducted at Clínica Universitaria Reina Fabiola, including patients with SpH who underwent laparoscopic transabdominal preperitoneal (TAPP) repair between June 2023 and March 2025. Clinical presentation, imaging findings, operative details, and postoperative outcomes were analyzed. Surgical repair consisted of reduction of the hernial contents, selective defect closure when indicated, and placement of a polypropylene mesh. Four patients were included, with a mean age of 36.5 years and a mean body mass index of 26.6 kg/m². All hernias were left-sided. Lower abdominal pain and palpable mass were the most frequent symptoms (75%). One patient required emergency surgery due to bowel obstruction, and one case was diagnosed incidentally. All diagnoses were confirmed by computed tomography (CT), with a mean hernial ring diameter of 2.1 cm. All patients underwent laparoscopic TAPP repair without intraoperative complications. The mean operative time was 75 min, and the mean hospital stay was 12 h. No postoperative complications or hernia recurrences were observed during follow-up. Laparoscopic TAPP repair for SpH is a safe, effective, and reproducible technique, even in emergency settings. Advantages include short operative time, prompt postoperative recovery, and a low risk of complications when performed by surgeons experienced in laparoscopic surgery.