LAUSR

Spigelian hernias are rare. Surgical treatment is often recommended. Different minimally invasive techniques are available by means of intraperitoneal or extraperitoneal mesh placement, either by IPOM, transabdominal preperitoneal (TAPP) or total extraperitoneal (TEP) approach. TEP approach is seldom reported in the literature. We present a short series of TEP repair of Spigelian hernias. Between February and October 2022, TEP repair was performed in two patients with unilateral Spigelian hernia, one case of bilateral hernia, and one combined unilateral Spigelian and inguinal hernia, ensuing the following technique. Preperitoneal access was achieved placing a contralateral 11mm trocar, a few centimetres above the umbilicus, posterior to the rectus muscle toward Retzius space. A 5mm trocar was placed suprapubic and another 11mm trocar at the flank. Working space is developed by blunt dissection. Spigelian hernia sac is dissected and reduced. At this point other inguinal or femoral hernias are explored, performing simultaneous repair if necessary. Sufficient preperitoneal space is ensured to allow correct overlap of a polypropylene self-gripping mesh, prior to closing the defect with barbed-polydioxanone suture. Median age was 72 years. Three cases were right hernias and two left, all diagnosed by imaging test due to symptoms. Latest discharge was 24 hours after surgery. No complications or recurrences were encountered at a median follow-up of 4 months. Comparative studies between minimally invasive approaches of Spigelian hernias are scarce. In the presented experience, TEP approach proved to be an efficient and reproducible technique with favourable results.