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AIM: The aim of this case series is to describe the pathophysiological, clinical, and radiological features of Spigelian hernias, and to describe their modern surgical management. MATERIAL OF STUDY: We describe the clinical management of four cases of Spigelian hernias, and we discuss the main issues and controversies in the current scientific literature. RESULTS: In all the cases the clinical suspect arouses during the clinical examination of the patients, and it was confirmed through imaging techniques. All cases were treated surgically by an open approach; no intraoperative or postoperative complications occurred, and no recurrences were registered. DISCUSSION: Our experience and the literature review that we carried out confirm that Spigelian hernia is a rare condition, and its diagnosis should always be based on a thorough clinical examination and possibly a ultrasound or computed tomography, which are important for the study of the exact anatomical features of the defect, and for the planning of the adequate operative approach. The laparoscopic technique is effective but used in few reference centers, both for the rarity of the disease and the long learning curve, whereas the open surgical correction is the most common approach, with excellent results, especially in cases where urgent repair is needed. CONCLUSION: The surgical treatment of Spigelian hernias has excellent results when a thorough clinical – radiological evaluation is carried out, and the appropriate surgical approach is chosen.