Objective <p>This study aimed to evaluate the clinical characteristics, diagnostic methods, surgical treatment approaches, and outcomes of Spiegel hernia, a rare type of abdominal wall hernia.</p> Materials and methods <p>Fifty patients diagnosed with Spiegel hernia at our clinic between January 2015 and June 2023 were retrospectively reviewed. The patients’ demographic characteristics, clinical presentations, diagnostic methods, surgical techniques, complications, and recurrence rates were evaluated.</p> Results <p>Thirty-one (62.0%) patients were female and 19 (38.0%) were male. The mean age was 58.6 ± 12.8 years. The most common presenting complaints were abdominal pain (84.0%) and palpable mass (66.0%). Computed tomography was found to be the most effective diagnostic method with 100% sensitivity. Of the 47 patients who underwent elective surgery (three emergency cases with strangulation were treated with open surgery and excluded from comparative analysis), 59.6% (<i>n</i> = 28) underwent laparoscopic surgery and 40.4% (<i>n</i> = 19) underwent open surgery. The mean follow-up period was 38.8 ± 18.4 months (median: 37 months, IQR: 24–54), and the overall recurrence rate was 4.3%. Hospital stay was significantly shorter in the elective laparoscopic approach (2.1 ± 0.7 vs. 3.8 ± 1.1 days, <i>p</i> &lt; 0.001).</p> Conclusion <p>Spiegel hernia is an important clinical entity due to its high risk of strangulation. Computed tomography is the gold standard for diagnosis. Laparoscopic repair is a safe treatment option with a shorter hospital stay. Early diagnosis and elective surgery are recommended. Despite the retrospective design, balanced group distribution in elective cases (28 laparoscopic vs. 19 open), the limited number of recurrence events (<i>n</i> = 2) and low statistical power for some comparisons require careful interpretation of the results.</p>