title: Standard of Open Surgical Repair of Suprapubic Incisional Hernias.
abstract: 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.
authors.affiliation: 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.
authors.forename: Yohann
authors.initials: Y
authors.lastname: Renard
authors.affiliation: Department of Gynecology-Obstetrics, Robert-Debré University Hospital, University of Reims Champagne-Ardenne, Reims, France.
authors.forename: Anne-Charlotte
authors.initials: AC
authors.lastname: Simonneau
authors.affiliation: Department of Hepato-Gastroenterology and Digestive Oncology, Robert-Debré University Hospital, University of Reims Champagne-Ardenne, Reims, France.
authors.forename: Louis
authors.initials: L
authors.lastname: de Mestier
authors.affiliation: Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, University of Reims Champagne-Ardenne, Rue Cognacq-Jay, 51092, Reims Cedex, France.
authors.forename: Lugdivine
authors.initials: L
authors.lastname: Teuma
authors.affiliation: Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, University of Reims Champagne-Ardenne, Rue Cognacq-Jay, 51092, Reims Cedex, France.
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Meffert
authors.affiliation: Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, University of Reims Champagne-Ardenne, Rue Cognacq-Jay, 51092, Reims Cedex, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Palot
authors.affiliation: Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, University of Reims Champagne-Ardenne, Rue Cognacq-Jay, 51092, Reims Cedex, France.
authors.forename: Reza
authors.initials: R
authors.lastname: Kianmanesh
mesh_terms: D034861:Abdominal Wall / Q000601:surgery; D000368:Aged; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods; D006801:Humans; D000069290:Incisional Hernia / Q000601:surgery*; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D011184:Postoperative Period; D012008:Recurrence; D012189:Retrospective Studies; D013526:Surgical Mesh