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

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

Spigelian hernia, Abdominal wall hernia, Open mesh repair, Polypropylene mesh, Case report

Abstract
Background Spigelian 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.
Conclusions These 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.
Clinical trial number
Not applicable.
Keywords Spigelian hernia, Abdominal wall hernia, Open mesh repair, Polypropylene mesh, Case report

Eren Ogut1* , Fatos Belgin Yildirim2

and Osman Memis3

https://doi.org/10.1186/s12245-025-01116-7

2026

peri irawan

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