title: Spigelian hernia.
abstract: We report on the evolution in concept and techniques that allowed us to improve the treatment of spigelian hernia, operable in day surgery in 90% of cases and through a preperitoneal and recently a preperitoneal and subfascial prosthetic repair (PHS).
  
  
  BACKGROUND
  We propose an innovative use of the PHS mesh for spigelian hernia repair. With this new implementation, we confront the standard surgical technique and its postoperative period.
  
  
  METHODS
  From January 1992 to March 2004, we performed 2,500 hernia surgical operations, including 32 spigelian hernia repairs (1.3% of total case series). The first surgical approach used for 20 of these 32 patients (62.5% of total spigelian hernias), all electively operated on, was a classical preperitoneal repair (Wantz), performed when possible by size of defect and weight (Body Mass Index) of the patient, under local anesthesia and on a day-surgery basis. Our new modified technique takes place through the insertion of a PHS large-type mesh, whose bottom underlay portion lies flat in the preperitoneal space with the connector obliterating the hernial orifice and with the overlay portion lying on the internal oblique muscle, covered by the aponeurosis of the external oblique muscle.
  
  
  RESULTS
  Our modification to the classical technique consisted only in the application of a product, such as the PHS, in a hernia defect, which presented with an orifice of the size of the connector and, therefore, was easily repairable with the use of the PHS device. This approach is easier than the preperitoneal approach, it's always suitable for local anaesthesia, and it gives a more comfortable postoperative period. The surgical approach may be performed completely in day surgery.
  
  
  CONCLUSIONS
  We believe that spigelian hernia surgical repair should always be performed by means of a preperitoneal prosthesis under local anaesthesia when the patient's clinical and physical conditions allow for it, always in day surgery, and using the PHS mesh when the hernia defect size fits with the connector diameter. This last possibility seems to be easier and more comfortable for the patient in the postoperative period.
authors.affiliation: Department of Surgical Sciences, University of Milano Policlinico Hospital I.R.C.C.S. Pad. Beretta Est, Via Francesco Sforza 35, 20122, Milano, Italy. giampiero.campanelli@unimi.it
authors.forename: G
authors.initials: G
authors.lastname: Campanelli
authors.forename: D
authors.initials: D
authors.lastname: Pettinari
authors.forename: F M
authors.initials: FM
authors.lastname: Nicolosi
authors.forename: E Contessini
authors.initials: EC
authors.lastname: Avesani
mesh_terms: D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000601:surgery; D006801:Humans; D019919:Prosthesis Implantation / Q000295:instrumentation*; D012189:Retrospective Studies; D013526:Surgical Mesh; D016896:Treatment Outcome