Open elective prosthetic repair of Spigelian hernias: long-term outcomes from a single-center experience

The primary objective was to describe a single-center experience in the elective surgical management of Spigelian hernia, analyzing surgical approaches, perioperative morbidity, and long-term outcomes, with an emphasis on the recurrence rate.

A descriptive, retrospective, single-center study was conducted on adult patients (≥18 years) undergoing elective Spigelian hernia repair at the Santa Cristina University Hospital (Madrid) between June 2010 and May 2025. Emergency surgeries, ASA IV patients, and contaminated surgical fields were excluded. Demographic data, comorbidities, surgical technique (open approach), morbidity, length of hospital stay, and recurrence were analyzed.

A total of 59 patients were included, with a mean age of 64 years (64.4% female) and a mean follow-up of 82 months (median 79). The most frequent presentation was pain associated with a mass (61%), and ASA II was the most common status (69.5%). Spinal plus local anesthesia was used in 62.7% of cases. The predominant approach was open repair with sublay mesh (91.5%), predominantly retromuscular (64.4% of sublay repairs). No intraoperative complications were reported. The postoperative seroma rate was 3.4%. Ambulatory surgery (same-day discharge) was performed in 50.8% of patients, and there were no readmissions. The recurrence rate was 3.4% (2 patients).

Elective open repair of Spigelian hernia using sublay mesh is a safe, effective, and durable technique. In our series, this approach was associated with minimal perioperative morbidity, no readmissions, and a very low recurrence rate, maintaining excellent long-term outcomes (median follow-up > 6 years).