doi:10.1111/j.1744-1633.2006.00290.x Case report Surgical Practice (2006) 10, 82–83 © 2006 College of Surgeons of Hong Kong Blackwell Publishing AsiaMelbourne, AustraliaASHSurgical Practice1744-16252006 Blackwell Publishing Asia Pty LtdMay 20061028283Case ReportBilateral Spigelian hernia treatmentS Naik et al. *Author to whom all correspondence should be addressed. Email: sorabhkapoor@hotmail.com Received 19 August 2005; accepted 29 November 2005. Case report Bilateral Spigelian hernia treated by two-layered prolene mesh Saleem Naik, Sorabh Kapoor,* Sandesh K. Sharma and Subodh Varshney Department of Gastrointestinal Surgery, Bhopal Memorial Hospital and Research Centre, Raisen Bypass Road, Karond, Bhopal, MP, India. Spigelian hernia is an uncommon variety of abdominal hernias. It has been traditionally treated by tension-free mesh hernioplasty. We report a rare case of a bilateral Spigelian hernia in an elderly male that was treated by bilateral two-layeyed prolene mesh hernia system. Rare ventral hernia such as Spigelian hernia with weak abdominal wall can be safely treated by tension-free mesh repair using bilayered prolene mesh system. Key words: hernia, prolene, Spigelian hernia, surgical mesh, ventral. Introduction Spigelian hernias are ventral hernias occurring through the Spigelian fascia along Spieghel’s semilunar line. 1 They lie under the external oblique aponeurosis lateral to the outer border of the rectus abdominis muscle. They commonly occur at a level referred to as the ‘Spigelian hernia belt’ which is a transverse band between the level of the umbilicus and the line joining both anterior superior iliac spines. 2 Although many cases of unilateral Spigelian hernia have been reported in the literature, bilateral adult Spigelian her- nias are rarely seen. We report a bilateral huge Spige- lian hernia that was repaired with prolene double mesh hernia system. Case report A 75-year-old man presented with a history of bilateral lower abdomen swelling and dull aching pain for 3 years. Abdominal examination revealed bilateral smooth infra-umbilical bulge lateral to the rectus abdo- minis muscle with positive cough impulse. An ultra- sound of the parietal wall was sought which reported the swelling to be a bilateral Spigelian hernia. The patient had no history of previous abdominal surgery. He had been operated on for benign prostatic hyper- plasia (transuretheral resection), 1 year ago and had underlying ischemic heart disease. Operative technique The procedure was conducted under spinal anaesthe- sia. The hernias were approached by two separate transverse incisions at the level of the anterior superior iliac spine, at the lateral border of the rectus muscle and extending 5 cm laterally. The external oblique apo- neuroses were opened along the direction of the fibers. Herniae were present on either side, lateral to the rectus sheath from defects in transverses abdominis and internal oblique muscles. The intact sacs were carefully separated from the margins of the defect and a preperitoneal space was developed all around the defect. A bilayered prolene mesh hernia system was used to repair the defect with the underlay patch posi- tioned in the preperitoneal space. Few circumferential stitches were used to fix the underlay mesh and the preperitoneal fascia. The onlay patch was positioned above the internal oblique muscle and sutured to the internal oblique aponeurosis over the superior, medial and superiolateral borders and the inguinal ligament over the inferiolateral border. The connector was posi- tioned to act as a plug in the parietal wall defect. The external oblique aponeurosis was closed over a suc- tion drain. The total operative time was 70 min and the blood loss was minimal. The patient was discharged a day after the surgery with drains in situ which were removed on the 4th postoperative day. Discussion Spigelian hernia is a rare ventral hernia. 3 Although paediatric Spigelian hernias have been described, 4,5 this hernia usually occur in patients over the age