Transabdominal Preperitoneal (TAPP) Approach for Spigelian Hernia: Our Clinical Experience and a Comprehensive Review of the Literature.

Introduction Spigelian hernia is a rare but clinically significant entity due to its high risk of incarceration, requiring prompt surgical intervention. Historically, the open approach was the preferred option; however, the current trend has shifted towards laparoscopic techniques. The transabdominal preperitoneal (TAPP) approach offers the advantage of satisfactory exposure with minimal invasion. This study aimed to review the management of Spigelian hernias and compare this with an institutional experience of surgical repair. Methodology  A retrospective analysis was undertaken of prospectively collected data from all patients who underwent repair of Spigelian hernias at a large District General Hospital (DGH) between 2018 and 2024. Data included patient demographics, diagnostic investigations, operative details, length of hospital stay, follow-up and recurrence. Results  The literature supports a laparoscopic approach, which is associated with fewer complications and shorter hospital stays compared to open repair. The institutional series included nine patients (male-to-female ratio, 4:5; median age, 75 years; body mass index (BMI), 24; and the American Society of Anesthesiologists (ASA) physical status class III). All patients underwent TAPP repair. There were no intraoperative complications, and the median hospital stay was one day. At a 12-month follow-up, there were no recurrences and one seroma, which was managed conservatively. Conclusions  TAPP repair appears to be a safe and effective approach for the treatment of Spigelian hernias. While these findings align with the existing literature, further studies with larger sample sizes are needed to confirm long-term outcomes.