Abstract：
OBJECTIVE: This retrospective study aims to describe morphological and therapeutic peculiarities of the suprapubic incisional hernia (SIH) encountered after a Joël-Cohen laparotomy.
METHODS: Serie-report: 9 patients had an SIH, 2 were sub-umbilical and did not concern the suprapubic scar, 3 were central, 2 on the whole length of the suprapubic scar, and 2 were bilateral in one case associated to a sub-umbilical incisional hernia.
RESULTS: SIH were wide openings, with a hernial fascia constituted from the anterior fascia, without connexion with the parietal peritoneum, in a sub-umbilical position above the suprapubic scar, or through the suprapubic scar. Rectus muscle was ruptured or sclerosed. There were 2 distinct defects, an anterior one through the anterior fascia, and a posterior one between the rectus muscles. The parietal peritoneum was retracted leaving bare the posterior side of the rectus muscles. There was an interstitial retro-fascial space, so the SIH was bisaccular. When releasing the parietal peritoneum was not feasible, the prosthesis was placed in a retro-fascial space. When the parietal peritoneum was released, the prosthesis was placed in a preperitoneal space. The anterior defect closure was not always completely feasible, fulfilled with a Vicryl prosthesis. One patient presents an abdominal wall bulging in case of efforts.
CONCLUSIONS: SIH after a Joël-Cohen laparotomy is wide and dilapidating. The cure is difficult. This technique should be reserved to real emergency obstetrical procedure. We highlight the importance of the parietal peritoneum closure after gynecological or obstetric surgery.
METHODS: Serie-report: 9 patients had an SIH, 2 were sub-umbilical and did not concern the suprapubic scar, 3 were central, 2 on the whole length of the suprapubic scar, and 2 were bilateral in one case associated to a sub-umbilical incisional hernia.
RESULTS: SIH were wide openings, with a hernial fascia constituted from the anterior fascia, without connexion with the parietal peritoneum, in a sub-umbilical position above the suprapubic scar, or through the suprapubic scar. Rectus muscle was ruptured or sclerosed. There were 2 distinct defects, an anterior one through the anterior fascia, and a posterior one between the rectus muscles. The parietal peritoneum was retracted leaving bare the posterior side of the rectus muscles. There was an interstitial retro-fascial space, so the SIH was bisaccular. When releasing the parietal peritoneum was not feasible, the prosthesis was placed in a retro-fascial space. When the parietal peritoneum was released, the prosthesis was placed in a preperitoneal space. The anterior defect closure was not always completely feasible, fulfilled with a Vicryl prosthesis. One patient presents an abdominal wall bulging in case of efforts.
CONCLUSIONS: SIH after a Joël-Cohen laparotomy is wide and dilapidating. The cure is difficult. This technique should be reserved to real emergency obstetrical procedure. We highlight the importance of the parietal peritoneum closure after gynecological or obstetric surgery.
摘要：
目的：这项回顾性研究旨在描述Joèl-Cohen剖腹手术后耻骨上切口疝（SIH）的形态和治疗特点。
方法：系列报告：9名患者患有SIH，2人在脐下，与耻骨上瘢痕无关，3是中央的，2在耻骨上疤痕的整个长度上，在一例与脐下切口疝相关的病例中，2例为双侧。
结果：SIH是宽开口，由前筋膜构成的疝筋膜，与顶叶腹膜没有联系，在耻骨上疤痕上方的脐下位置，或者通过耻骨上的疤痕.直肌破裂或硬化。有两个明显的缺陷，一个通过前筋膜的前一个，和一个位于直肌之间的后部。顶叶腹膜缩回，使直肌的后侧裸露。有一个间质的后筋膜空间，所以SIH是双音。当释放顶叶腹膜不可行时，假体放置在筋膜后空间。当顶叶腹膜被释放时，假体放置在腹膜前间隙.前缺损闭合并不总是完全可行的，用Vicryl假体完成。一名患者在努力的情况下出现腹壁隆起。
结论：Joèl-Cohen剖腹手术后的SIH是广泛和破旧的。治疗是困难的。此技术应保留给真正的紧急产科程序。我们强调了妇科或产科手术后关闭顶叶腹膜的重要性。
方法：系列报告：9名患者患有SIH，2人在脐下，与耻骨上瘢痕无关，3是中央的，2在耻骨上疤痕的整个长度上，在一例与脐下切口疝相关的病例中，2例为双侧。
结果：SIH是宽开口，由前筋膜构成的疝筋膜，与顶叶腹膜没有联系，在耻骨上疤痕上方的脐下位置，或者通过耻骨上的疤痕.直肌破裂或硬化。有两个明显的缺陷，一个通过前筋膜的前一个，和一个位于直肌之间的后部。顶叶腹膜缩回，使直肌的后侧裸露。有一个间质的后筋膜空间，所以SIH是双音。当释放顶叶腹膜不可行时，假体放置在筋膜后空间。当顶叶腹膜被释放时，假体放置在腹膜前间隙.前缺损闭合并不总是完全可行的，用Vicryl假体完成。一名患者在努力的情况下出现腹壁隆起。
结论：Joèl-Cohen剖腹手术后的SIH是广泛和破旧的。治疗是困难的。此技术应保留给真正的紧急产科程序。我们强调了妇科或产科手术后关闭顶叶腹膜的重要性。
