The elective treatment of a spigelian hernia is still under discussion, fundamentally owing to its rarity. The purpose of the study is to analyze the elective surgical treatment of spigelian hernia.Design: A prospective, randomized controlled trial.Setting: University teaching hospital.Patients and Interventions: Two surgeons performed 11 conventional and 11 laparoscopic repairs for a spigelian hernia, alternating roles as primary surgeon and assistant. Each time the type of technique was randomly chosen using a computerized program.Main Outcome Measures: Epidemiological, clinical, and surgical factors are analyzed according to treatment, ie, the open or laparoscopic approach.Results: The statistical study shows no significant differences for epidemiological or diagnostic factors, but it does show significant advantages for laparoscopy in terms of morbidity (PϽ.05) and hospital stay (PϽ.001). Conclusion:The approach using extraperitoneal laparoscopy is the technique that offers best results in the elective treatment of spigelian hernia.

The laparoscopic approach to secondary lumbar hernia repair is more efficient and more profitable than the traditional open technique.

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1) Intra-abdominal composite mesh is good tolerance. 2) The recurrence rate is low and within 1 year of the operation. 3) The long-term morbidity with LIHR is moderate. 4) The risk of intestinal injury is not predictable. 5) Reoperations can be performed with sufficient guarantee using laparoscopy.

Spigelian hernias are rare defects of the abdominal wall. Our aim is to analyse the bibliography and present a series of 28 patients. A Medline bibliographical study was performed between 1970 and 2000 with analysis of the number of cases, series, ratio of cases to year and type of journal. We also present a personal study and analyse epidemiological, diagnostic, and treatment factors. There are 159 articles, 479 cases, and 19 series of more than five patients published in 85 journals (42.3% medical). Our diagnosis was preoperative in 75%, and programmed surgery was 3.6 times more common than emergency surgery. We found a significant relationship between hospital stay and type of surgery (P < 0.02) and surgical technique used (P < 0.001). We found that spigelian hernias have a multidisciplinary interest; they are given almost equal treatment in medical and surgical journals; preoperative diagnosis can be established in 75% of cases; and the best results are offered by the extraperitoneal laparoscopic approach.