Laparoscopic repair for Spigelian-inguinal hernia complex: A case report and review of literature.

Abstract

<h4>Introduction and importance</h4>Spigelian hernia, a rare primary abdominal wall defect accounting for 2 % of all hernias, poses diagnostic challenges due to its anatomical proximity to the semilunar line. Its coexistence with inguinal hernia further complicates management. This report introduces an innovative laparoscopic approach for concurrent Spigelian-inguinal hernia repair.<h4>Case presentation</h4>A patient presented with left lower abdominal and inguinal pain. CT revealed a 4-cm Spigelian hernia ring. We performed the modified TAPE technique combining TAPP and IPOM principles: The hernia sac was reduced transabdominally, followed by preperitoneal mesh placement with peritoneal flap closure. Postoperative recovery was uneventful, with discharge on day 3. Three-month follow-up confirmed durable repair without complications.<h4>Clinical discussion</h4>Spigelian hernia carries higher incarceration risks due to narrow fascial defects. While imaging advances improve detection rates, 30-50 % are initially misdiagnosed. Our modified TAPE technique addresses dual challenges: 1) Preperitoneal mesh placement avoids visceral contact seen in IPOM; 2) Peritoneal flap closure prevents mesh migration. Comparative studies show laparoscopic approaches reduce recurrence rates (1.2 % vs 4.7 % open) with shorter hospital stays.<h4>Conclusion</h4>This case validates the modified TAPE technique as a safe, effective solution for Spigelian-inguinal hernia complex. The hybrid approach leverages laparoscopic advantages while mitigating traditional limitations, demonstrating 100 % early success in our series. This strategy warrants broader application in specialized hernia centers.