Renard Yohann, Simonneau Anne-Charlotte, de Mestier Louis, Teuma Lugdivine, Meffert Jean-Luc, Palot Jean-Pierre, Kianmanesh Reza
Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, University of Reims Champagne-Ardenne, Rue Cognacq-Jay, 51092, Reims Cedex, France.
Department of Gynecology-Obstetrics, Robert-Debré University Hospital, University of Reims Champagne-Ardenne, Reims, France.
World J Surg. 2017 Jun;41(6):1466-1474. doi: 10.1007/s00268-017-3892-z.
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.
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.
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%.
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.
耻骨上切口疝（SIH）是一种罕见的腹壁缺损，由于相关文献有限，其手术治疗具有挑战性。疝与骨骼、血管、神经和泌尿系统结构接近，且该部位缺乏腹直肌后鞘，这意味着需要采用适当的手术修复技术。我们旨在描述一组接受妇科手术后因耻骨上切口疝接受手术治疗的女性患者，并报告手术结果。
回顾性分析2009年1月至2015年1月在一家专业外科中心接受耻骨上切口疝手术的所有连续患者的病历。采用相同的开放技术，即在Retzius腹膜前间隙下方放置补片，补片有较大重叠，通过肌肉向上和向外强力固定在库珀韧带上，补片处于sublay或underlay位置。
该队列包括71名女性患者。31%的患者耻骨上切口疝复发，32例（45.1%）与剖宫产有关，39例（54.9%）与妇科手术有关。76.1%的患者补片完全位于腹膜外。术后死亡率为零。特定手术并发症发生率为29.6%。中位随访30.3个月后，复发率为7%。
耻骨上切口疝修复的开放手术方法安全有效。由于缺乏充分的科学研究，这种可重复的开放方法有助于耻骨上切口疝手术治疗的标准化。
