The challenge of infraumbilical sovrapubic hernia

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The challenge of infraumbilical sovrapubic hernia

• Paolo Bocchi

Azienda Ospedaliera Universitaria Parma
Italy Clinica Chirurgica Generale
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Presentation
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Frequency

• Infraumbilical
• Super and Infraumbilical
• Epigastric
• Inguinal DX
• Subcostal DX
• Posterolateral

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Frequency214 patients

• Super and infraumbilical
• Infraumbilical
• Epigastric
• Inguinal DX
• Subcostal DX
• Mercedes Incision
• Posterolateral

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Infraumbilical hernia

• Traumatic
• Iatrogenic
• Incisional
• Parapubic hernia

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Peculiarity
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Incisional parapubic hernias.Bendavid
R.Shouldice Hospital, Thornhill, Ontario,
Canada.
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This hernia results from the disruption of the
musculotendinous elements of the abdominal wall
as they insert into the pubis.
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Caused by multiple previous operations through
the lower abdominal wall, procedures of a
gynecologic or urologic nature or a acute
disinsertion caused by a trauma The herniation
mimics an incisional or inguinal hernia, and a
defect that cannot possibly be corrected without
the use of a prosthesis.
Parapubic hernia is considered rare. ( 18
described)
It presents a therapeutic challenge because there
is no strong aponeurotic anchoring structure in
the defect's caudal aspect.
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Principle of operation
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Typical operation
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Parapubic
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Sometime if there are respiratory problems
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Laparoscopic treatment of parapubic
postprostatectomy hernia.Matuszewski M, Stanek
A, Maruszak H, Krajka K.
Arch Surg. 2001 Nov136(11)1314-7. Laparoscopic
repair of parapubic hernia.Hirasa T, Pickleman
J, Shayani V.
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Ours attitude

• Small laparoscopic
• Medium, common Rives Op.
• Large, life theatening Chevrel Op.

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Thank you