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A 65-year-old woman presented with a chief complaint of swelling of the left inguinal region. Abdominal CT showed protrusion of fatty tissue at the left lateral margin of the rectus abdominis muscle. A left Spigelian hernia was diagnosed, and laparoscopic hernia repair was performed by a totally extraper-itoneal approach (TEP). A left direct inguinal hernia was also noticed during surgery, and both hernias were repaired at the same time using mesh. Spigelian hernias with fragility of the abdominal wall may occur with other hernias. Laparoscopic surgery can be useful for simultaneous diagnosis and repair.

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