Enhanced laparoscopic transabdominal preperitoneal plus technique with dual defect closure for spigelian hernia: A novel modification and technical insight

Spigelian hernia (SH) is a rare lateral abdominal wall defect that poses diagnostic and technical challenges, especially in large cases. Conventional laparoscopic approaches, such as intra peritoneal onlay meshplasty, total extra peritoneal and standard transabdominal preperitoneal (TAPP), may fall short in achieving ideal closure and mesh placement. We report two female patients presented with left flank swelling and intermittent pain. Imaging confirmed SHs measuring 4-5 cm. Both patients underwent laparoscopic repair using a modified TAPP plus technique. This approach combines transfascial sutures with intracorporeal reinforcement, enabling tension-free closure and optimal mesh fixation while preserving neurovascular structures. Both patients recovered uneventfully, were discharged on post-operative day 1, reported minimal pain and returned to normal activities within 10 days. At 8-month follow-up, no complications or recurrences were observed. The modified TAPP plus technique represents a novel and feasible technique for SH repair, ensuring tension-free closure, secure mesh fixation and early recovery.