Open and laparoscopic repair of Spigelian hernia.

Spigelian hernia is an uncommon ventral wall hernia. Because of the infrequent occurrence of a Spigelian hernia, the optimal surgical repair technique is not patently established in the surgical literature. A series of 4 consecutive patients who underwent surgical repair of a Spigelian hernia is reported with complete long-term follow-up. Each patient was referred for evaluation of point tenderness of the lower abdominal wall. A hernia bulge was found in the Spigelian hernia belt during physical examination of each patient. Clinical awareness of the Spigelian hernia by physical examination occurred best by palpation of the abdominal wall with the patient coughing or straining while in the standing position. The first Spigelian hernia was surgically repaired by an open procedure with primary fascial closure of the hernia defect reinforced with an onlay mesh. A laparoscopic transabdominal preperitoneal mesh repair was performed in the remaining 3 patients. No recurrence of the Spigelian hernia occurred in any of the patients in this series, who were evaluated yearly by physical examination after the hernia repair. The open Spigelian hernia primary fascial repair with onlay mesh and the laparoscopic transabdominal preperitoneal Spigelian hernia mesh repair were uncomplicated surgical procedures that required customary and normal surgical technical skill.