The Joel-Cohen laparotomy: A dilapidating access source of wide and complex suprapubic incisional hernia

This retrospective study aims to describe morphological and therapeutic peculiarities of the suprapubic incisional hernia (SIH) encountered after a Joël-Cohen laparotomy.

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.

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 The parietal peritoneum was retracted leaving bare the posterior side of the rectus muscles.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.

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.