Background: Is to describe the pathological, clinical and radiological features of Spigelian hernia, and to compare between open and laparoscopic methods of its surgical treatment.   Patients and methods: We describe the clinical management of 20 cases of Spigelian hernias as regard patient complaint, clinical examination, radiological investigations, and the surgical approach that was randomly performed either open or laparoscopic intraperitoneal only mesh.   Results: In all cases, the suspicion aroused during the clinical examination of the patients, and it was confirmed via imaging techniques. 10 cases were treated through open surgical approach, no intraoperative or postoperative complications have occurred, 3 patients had postoperative small wound seroma which resolved spontaneously, Other10 cases were treated through laparoscopic intraperitoneal onlay mesh repair with no intraoperative or postoperative complications. No recurrences had been observed for both groups in 24 months period of the study.   Conclusion: Spigelian hernia is a rare entity; its diagnosis is depending on a thorough clinical examination and must be confirmed by imaging studies especially CT scan which is the modality of choice for its diagnosis. Open surgical repair is considered the standard method for treatment due to its rarity but laparoscopic intraperitoneal onlay mesh repair is also safe and effective with shorter postoperative hospital stay.