Revisiting Spigelian hernia with emphasis on diagnostic challenges and outcomes of open mesh repair: a case report of two patients.

backgroundSpigelian hernia is a rare defect of the anterior abdominal wall, accounting for less than 2% of all abdominal wall hernias. Despite its low incidence, it carries a clinically significant risk of incarceration and strangulation due to its deep interparietal location beneath an intact external oblique aponeurosis, which often delays the diagnosis. CASE PRESENTATIONS: This report presents two surgically treated cases of Spigelian hernia and focuses on the operative outcomes and refinement of the open repair technique. Both patients were men aged 65 and 61 years, respectively, and presented with unilateral lower abdominal wall swelling that became more prominent during standing or straining. Clinical examination and preoperative ultrasonography confirmed the diagnosis in both cases, revealing fascial defects along the semilunar line, below the arcuate line. Open anterior repair was performed under spinal anaesthesia in both cases. The hernia sac was reduced without opening, and a polypropylene mesh was placed in an onlay position with adequate overlap and secured using non-absorbable sutures. In one patient, a concomitant inguinal hernia was repaired during the same surgical session. Postoperative recovery was uneventful in both patients. Follow-up at 6 and 12 months revealed no recurrence, chronic pain, or mesh-related complications.

conclusionsThese cases demonstrate that open mesh repair is a safe and effective treatment option for Spigelian hernias, particularly in complex or urgent clinical settings. The choice of surgical approach should be individualized based on anatomical characteristics and the overall clinical context.