Spigelian Hernia: Case Series and Review of the Literature.

Background: Spigelian hernia (SH) is an uncommon ventral abdominal hernia. Traditionally repaired with an open technique, the laparoscopic approach is becoming more common and widely described in the literature. We hold that the transabdominal preperitoneal (TAPP) approach restores the anatomy and prevents complications such as seroma. We present a series of SH repair carried out at a single district general hospital over the past 13 years and a review of the literature.

Methods: A retrospective case note review identified SH repaired between January 2005 and March 2018 at The Queen Elizabeth Hospital, King's Lynn, Norfolk, UK. A Medline search for 'Spigelian hernia' and 'laparoscopic' revealed 41 papers for review.

Results: 33 patients underwent repair of SH. We found that the TAPP repair with a mesh is anatomically the most sound repair, with all the added benefits of keyhole surgery, i.e. reduced hospital stay, quicker recovery, and fewer infections. Our complication rates matched those described in the literature.

Conclusions: Several operative techniques have been described to repair SH. We favour the laparoscopic TAPP approach which is safe, aids in confirming the correct diagnosis, and has all the benefits of keyhole surgery.