Spigielian hernias are a rare hernia which in some patients manifests only as pain. They occur just lateral to the rectus sheath and superior to the epigastric vessels and inferior to the linea semicircularis. Hernias inferior to toe epigastric vessels are considered direct inguinal hernias.
These are unusual and difficult to diagnose hernias because the sac may remain below the external oblique fascia. They may cause pain but only a vague bulge palpable only in slender patients. Repair is a layered suture repair through a transverse skin incision.
"Milan—Chronic groin pain after hernia surgery is now considered the most important issue facing inguinal hernia surgeons and their patients. Yet, there is still much uncertainty surrounding what causes the pain and how to prevent it." - Victoria Stern, General Surgery News