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Background: Epigastric hernias are 0.35-1.5% of abdominal hernias and 8% of midline ones. They are often of small dimensions (15-25 mm) but voluminous epigastric hernias (5-10 cm) may occur. In these cases the sac may contain epiploic appendages or viscera (ileum loops, stomach). 20% of epigastric hernias are multiple: for this reason we must consider the integrity of the whole linea alba. Ultrasound scan, showing a 100% sensibility towards this pathology, is extremely effective to achieve this aim., Methods: We have reviewed our experience since 1989 analysing the clinical, diagnostical and therapeutical aspects and pointing out the not too distinct symptomatology of epigastric hernias, including those complicated by incarceration. We always carry out surgical correction of epigastric hernias in general anaesthesia and open the peritoneal sac in order to loosen possible adhesions. We have employed a properitoneal MESH (polypropylene) only in voluminous hernias., Results: In a two years follow-up in 79% of patients, no recurrences have been observed., Conclusions: The surgical correction of epigastric hernias does not always need a prosthesis, but it may be a simple direct reconstruction as long as the suture is carried out in the correct direction depending on the dimensions of the hernial porta. On the other hand, recurring epigastric hernias and voluminous hernias, multiple or isolated, can be corrected with a polypropylene MESH placed in the properitoneal area.

Spigelian hernia is an uncommon hernia of the abdominal wall, often not easily diagnosed. Three cases of Spigelian hernia are reported. In the first patient it was an incidental discovery, in the second one hernia was complicated by strangulation of the small bowel, in the third patient hernia was symptomatic without complications. In all the patients, in their previous clinical history, an operation for hernia or other abdominal pathologies was observed. These patients were treated surgically, using direct reconstruction of the abdominal wall in two cases, while a non-absorbable mesh was positioned in the preperitoneal space in the third patient. The anatomopathological and clinical features of Spigelian hernia are described and the problems in diagnosis discussed; in addition, the importance of surgical cure in incidental hernia is underlined.

Two cases of Spigelian hernia are reported. Starting from the analysis of these cases, some observations about the anatomy, the etiology, clinic, diagnostic methods and the best therapeutic choices now available for this uncommon pathology are presented.

A rare case of bilateral spigelian hernia is presented and the anatomy and clinical problems related to this disease are discussed. The role of TC scan in the diagnosis of cases with difficult clinical evaluations is stressed.

Ventral lateral hernias of the abdominal wall are rare. On the basis of their location we can classify them as follows: hernias of the aponeurosis of the transversus muscle, hernias of the rectal sheath and transmuscular hernias of the iliac region. In a group of 3134 hernias of the abdominal wall observed in a period of 16 years, 11 ventral lateral hernias have been encountered (0.3%). The diagnosis often presents great difficulties as the symptoms and the clinical findings are not typical. They must be differentiated from hematomas of the rectus sheath, abscess or intra-abdominal processes. Echography and Computed Tomography have an important role in their detection. Nevertheless in some patients the true diagnosis is reached only intraoperatively. The treatment generally consists in surgical correction by layer closure of the fascial or muscular defect. In selected cases the use of prosthetic material and video laparoscopic repair are indicated.

The authors describe a case of Spigelian hernia observed and treated. This hernia is uncommon, although the true incidence is probably greater than the small number of patients reported in literature. The signs and symptoms of the hernia are not always characteristic and then a correct diagnosis can be difficult. Sometime instrumental examination is essential for diagnosis, when clinical examination is not clear. Surgical repair as mandatory for a correct reconstruction of the abdominal wall and a prevention of recurrences.

The Authors report a small series (three cases) of Spigelian hernias and underline the rarity of this pathology (0.2% in their series of hernias of the abdominal wall). They determine the anatomical features of the region, recall clinical features and discuss the most interesting points differential diagnosis and therapy.