Laparoscopic modified lateral transabdominal preperitoneal approach for Spigelian hernia repair: An easier approach to a rare condition.

Introduction: Both laparoscopic and open approaches are well accepted for spigelian hernia (SH) repair. Several techniques for SH repair are described in literature. In our study, eight patients underwent laparoscopic SH repair. A modified lateral TAPP approach was used in four cases and then compared with the conventional TAPP approach.

Methods: From January 2015 to January 2017, eight cases of SH were treated using the laparoscopic TAPP approach. Four cases underwent surgery by the conventional laparoscopic TAPP approach (group I). For the other four, modified lateral approach transabdominal preperitoneal technique was used (group II). Postoperative pain, operative time, length of hospital stay, and complications were compared between the groups. Patients were followed up for a minimum period of 1 year.

Result: Among the eight cases, the mean age was 52 years in group I and 50 years in group II, mean defect size was 23 mm in group I and 28 mm in group II, mean length of hospital stay was 1.50 days in group I and 1.25 days in group II, and operative time was 61 minutes in group I and 51 minutes in group II. There was no remarkable difference in complications or length of hospital stay between the groups. The groups were comparable in all other parameters, but the lateral approach was ergonomically better for the surgeon.

Conclusion: Of the approaches described for laparoscopic SH repair, the modified lateral TAPP approach is more convenient because it provides better and more adequate lateral and inferior space access and is ergonomically better for surgeons.