Introduction: Spigelian hernias are probably the best known among the rare hernias. However, a deep understanding of the local anatomy of the abdominal wall is essential to not only diagnose these often hardly to detect defects but also to provide a tailored repair. Methods: The variations of spigelian hernias and the underlying anatomy are discussed, as well as the clinical modalities from examination, imaging to the adequate choice of surgery. The standard of care nowadays is the preperitoneal mesh placement in laparoscopic techniques and the sublay position when open surgery is performed. Special focus is devoted in explaining the operative steps in open repair, because detection of the defect can be tricky for the surgeon with limited experience treating spigelian hernias. A case report and elucidating illustrations on anatomy complete this concise chapter. Results: Spigelian hernias are rare, but not totally uncommon (1–2% of all hernias), and they should always be included in differential diagnosis when exploring a patient for unclear (mostly right-sided) unilateral pain of the lower abdomen. CT or MRI will verify the assumption, and laparoscopy should generally be preferred over open repair in suitable patients.
Conflict of Interest: The authors, Drs. Petter-Puchner, Gruber-Blum, and Glaser report no conflict of interest.
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