Yohann Renard1, Anne-Charlotte Simonneau2, Louis de Mestier3, Lugdivine Teuma4, Jean-Luc Meffert4, Jean-Pierre Palot4, Reza Kianmanesh4. 1. Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, University of Reims Champagne-Ardenne, Rue Cognacq-Jay, 51092, Reims Cedex, France. yrenard@chu-reims.fr. 2. Department of Gynecology-Obstetrics, Robert-Debré University Hospital, University of Reims Champagne-Ardenne, Reims, France. 3. Department of Hepato-Gastroenterology and Digestive Oncology, Robert-Debré University Hospital, University of Reims Champagne-Ardenne, Reims, France. 4. Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, University of Reims Champagne-Ardenne, Rue Cognacq-Jay, 51092, Reims Cedex, France.
Abstract
BACKGROUND: Suprapubic incisional hernias (SIH) are a rare wall defect, whose surgical management is challenging because of limited literature. The proximity of the hernia to bone, vascular, nerve, and urinary structures, and the absence of posterior rectus sheath in this location imply adequate technique of surgical repair. We aimed to describe a cohort of female patients operated on for SIH after gynecological surgery using a homogeneous surgical technique and to report surgical outcomes. METHODS: The records of all consecutive patients operated on for SIH in a specialized surgical center between January 2009 and January 2015 were retrospectively reviewed. The same open technique was performed, i.e., using a mesh placed inferiorly in the preperitoneal space of Retzius, with large overlap, and fixed on the Cooper's ligaments, through the muscles superiorly and laterally with strong tension, in a sublay or underlay position. RESULTS: The cohort included 71 female patients. SIH were recurrent in 31% of patients and was related to cesarean in 32 patients (45.1%) and to gynecologic surgery in 39 patients (54.9%). The mesh was totally extraperitoneal in 76.1% of patients. The postoperative mortality rate was null. The rate of specific surgical complications was 29.6%. After a median follow-up of 30.3 months, the recurrence rate was 7%. CONCLUSION: The open approach for SIH repair was safe and efficient. Due to the paucity of adequate scientific studies, this reproducible open method could help moving toward a standardization of SIH surgical management.
BACKGROUND:Suprapubic incisional hernias (SIH) are a rare wall defect, whose surgical management is challenging because of limited literature. The proximity of the hernia to bone, vascular, nerve, and urinary structures, and the absence of posterior rectus sheath in this location imply adequate technique of surgical repair. We aimed to describe a cohort of female patients operated on for SIH after gynecological surgery using a homogeneous surgical technique and to report surgical outcomes. METHODS: The records of all consecutive patients operated on for SIH in a specialized surgical center between January 2009 and January 2015 were retrospectively reviewed. The same open technique was performed, i.e., using a mesh placed inferiorly in the preperitoneal space of Retzius, with large overlap, and fixed on the Cooper's ligaments, through the muscles superiorly and laterally with strong tension, in a sublay or underlay position. RESULTS: The cohort included 71 female patients. SIH were recurrent in 31% of patients and was related to cesarean in 32 patients (45.1%) and to gynecologic surgery in 39 patients (54.9%). The mesh was totally extraperitoneal in 76.1% of patients. The postoperative mortality rate was null. The rate of specific surgical complications was 29.6%. After a median follow-up of 30.3 months, the recurrence rate was 7%. CONCLUSION: The open approach for SIH repair was safe and efficient. Due to the paucity of adequate scientific studies, this reproducible open method could help moving toward a standardization of SIH surgical management.
Authors: Laurel J Blair; Tiffany C Cox; Ciara R Huntington; Samuel W Ross; Jeffrey S Kneisl; Vedra A Augenstein; B Todd Heniford Journal: Am Surg Date: 2015-07 Impact factor: 0.688
Authors: Antonia W Shand; Jian Sheng Chen; Margaret Schnitzler; Christine L Roberts Journal: Aust N Z J Obstet Gynaecol Date: 2014-11-28 Impact factor: 2.100
Authors: R W Luijendijk; J Jeekel; R K Storm; P J Schutte; W C Hop; A C Drogendijk; F J Huikeshoven Journal: Ann Surg Date: 1997-04 Impact factor: 12.969
Authors: Yohann Renard; Sophie Lardière-Deguelte; Louis de Mestier; François Appere; Alban Colosio; Reza Kianmanesh; Jean-Pierre Palot Journal: Surgery Date: 2016-06-01 Impact factor: 3.982