Spigelian Hernia: Diagnostic Challenges And Therapeutic Approaches: Report of Fourteen Clinical Cases

Background Although Spigelian hernia is rare, it should not be underestimated because of its significant risk of strangulation. The scarcity of studies and the absence of large, comprehensive case series on this pathology often makes clinical decision-making, despite appearing straightforward, both challenging and ambiguous. Methods This is a retrospective, monocentric study, conducted between January 2013 and December 2022, involving 14 patients who underwent surgery for a Spigelian hernia in the General Surgery Department of Charles Nicole Hospital in Tunis. Various epidemiological, clinical, radiological, and therapeutic factors were analysed using univariate analysis and logistic regression analyses. Results Fourteen patients with Spigelian hernia were recruited. The mean patient age was 62 years. All patients had predisposing factors for increased intra-abdominal pressure, and 50% had a history of abdominal surgery. The most common symptom was lateralized abdominal pain. Diagnosis was supported by imaging in 85.7% of cases, with CT scans being particularly helpful in emergency settings. Surgical repair was performed in all patients, predominantly via an open approach (92.8%). Primary suture repair was used in 64.2% of cases, while mesh repair was performed in 35.7%. The postoperative course was uneventful in 85.7% of patients. Morbidity was 14.2%, with no mortality. One recurrence was observed during follow-up. Conclusions Despite its rarity, Spigelian hernia should be considered in the differential diagnosis of localized abdominal pain. Imaging, particularly CT, plays a key role in diagnosis. Surgical repair, whether by suture or mesh, offers favorable outcomes with low morbidity and recurrence rates.