Incisional parapubic hernias.

A parapubic hernia, distinct from other lower abdominal wall hernias, is identified as a particular type of incisional hernia. This hernia results from the disruption of the musculotendinous elements of the abdominal wall as they insert into the pubis. This disruption is brought about by either the destruction of these musculotendinous tissues at their lower end or the resection of portions of the pubic bone as is sometimes done in suprapubic radical prostatectomies for easier access to the prostate. Seven cases have been identified and reported. Men and women were seen to make up a clinical picture that is suggestive of the diagnosis, namely, multiple previous operations through the lower abdominal wall, procedures of a gynecologic or urologic nature, a herniation that mimics an incisional or inguinal hernia, and a defect that cannot possibly be corrected without the use of a prosthesis. When the diagnosis is accurately established, the polypropylene mesh is inserted in the preperitoneal space and anchored laterally to the ligaments of Cooper and in between to the arcuate pubic ligament and the periosteum of the posterior aspect of the pubis. Excellent results have been obtained, and the success must be ascribed to the recognition of the parapubic hernia as a distinct entity.