External supravesical hernias with ovarian incarceration have not been reported previously. Here, we describe transabdominal preperitoneal (TAPP) repair of an external supravesical hernia with ovarian incarceration. A 68-year-old woman presented to our outpatient clinic with the chief complaint of right inguinal swelling and pain. A 3-cm-diameter mass in the right inguinal region that was difficult to reduce was palpable, and computed tomography (CT) revealed a suspicious lesion of the right hydrocele of the canal of Nuck. Hydrocelectomy was performed through an inguinal incision, and the external inguinal ring was repaired using the Marcy method. The histopathological examination confirmed the diagnosis of the canal of Nuck. Three months postoperatively, the patient again presented with right inguinal pain, and CT revealed a right femoral hernia requiring surgical repair. Intraoperative findings revealed a right external supravesical hernia with an incarcerated ovary, which was laparoscopically reduced and repaired with a mesh. At the three-month follow-up, there were no postoperative complications or recurrences. Incarcerated ovaries with inguinal hernias have been reported in girls; however, incarcerated ovaries with external supravesical hernias have not been reported in women. Although the preoperative diagnosis was difficult to make in this case, the laparoscopic approach led to the diagnosis and successful mesh repair. Although optimal mesh repair of external supravesical hernias using TAPP has not been established, we believe that 2-5 cm around the hernial orifice, the Hesselbach triangle, and the lateral triangle should be covered with mesh.

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.

BACKGROUND: Herein, we describe a novel technique for suprapubic incisional hernia repair using a modified transabdominal partial extraperitoneal technique in four patients.
METHODS: We implemented four-trocar placement to achieve a coaxial setting for the pubic bone. The pubic bone and Cooper\'s ligament were exposed by an incision dorsal to the hernial orifice, and the bladder was mobilized as an inferior peritoneal flap. The retropubic space was dissected approximately 5 cm from the hernial defect and this was closed with an intracorporeal non-absorbable barbed suture. A mesh was introduced into the intra-abdominal cavity, positioned to cover the closed defect, and tied to Cooper\'s ligament, the pubic bone, and rectus muscles. The dissected peritoneal flap was reattached to the abdominal wall by tacking and suturing.
CONCLUSIONS: The modified transabdominal partial extraperitoneal technique for suprapubic incisional hernia repair may contribute to decreased recurrence and seroma formation.

BACKGROUND: Our purpose was to determine whether vaginal hernia is a predisposing factor for incisional hernia (IH) in a cohort of women with symptomatic pelvic organ prolapse (POP) who underwent corrective repair by open mesh sacrocolpopexy (MSC) and had long-term follow-up to determine their rate of subsequent IH.
METHODS: Following IRB approval, the charts of women entered into a longitudinal database and who underwent open MSC at a tertiary institution were reviewed. Data collected included demographics, MSC and IH details, and long-term outcome. Patients were excluded if the follow-up after MSC was < 1 year. Data were reviewed by a neutral investigator who was not involved in patient care (FA).
RESULTS: From 1999 to 2012, 75 of 88 women met inclusion criteria, with mean follow-up of 65 (48-84) months. Thirteen were either lost to follow-up or had follow-up < 1 year. Seven women underwent symptomatic IH repair, with a mean onset of IH diagnosis after MSC at 18 (range 8-72) months. Five repairs were done via an open approach, and two were repaired laparoscopically. No IH recurrence was noted at a mean of 41 (range 14-75) months after IH repair. No risk factors were identified in the IH group compared with those who did not form a secondary IH.
CONCLUSIONS: In this longitudinal series, IH after open MSC occurred in 9.3%, a rate comparable with that reported in women undergoing abdominal procedures through midline or Pfannenstiel incisions.