Primary ventral or groin hernia in pregnancy: a cohort study of 20,714 women

Oma, Erling; Bay‐Nielsen, Morten; Jensen, Kristian K.; Jørgensen, Lars N.; Pinborg, Anja; Bisgaard, Thue

doi:10.1007/s10029-017-1618-7

Cited by 31 publications

(31 citation statements)

References 16 publications

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“…No complications occurred during childbirth. The same results have recently been published for women with diagnosed groin hernias in pregnancy [13]. Strong points of the study are the longest observational period for RLV in published literature, the complete follow-up and the comprehensive evaluation of potential risk factors, co-morbidities, pregnancy-and birthrelated data.…”

Section: Discussionsupporting

confidence: 61%

Is round ligament varicosity in pregnancy a common precursor for the later development of inguinal hernias? The prospective analysis of 28 patients over 9 years

Lechner

Bittner

Borhanian

et al. 2019

Hernia

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Purpose Short-term effects of round ligament varicosity (RLV) in pregnancy have been investigated in small-scale studies. The long-term effects are unknown. This study aims to evaluate the risk of groin hernia manifestation after RLV in pregnancy, to delineate possible risk factors and to analyze the natural course of pregnancy and post-partum period with regard to RLV. Methods In a prospective analysis 28 pregnant women with RLV presented to the hernia clinic over 9 years. After clinical and ultrasound examination during pregnancy and publication of early results in 2013 a second structured follow-up was conducted. Demographic data, hernia-specific risk factors, comorbidities, pregnancy and birth-related data as well as postpartum period were documented without loss of follow-up. In these women, all pregnancies that occurred, including the ones without RLV, were analyzed. Results Median follow-up was 68 months (11.4-104.9). Only one groin hernia was found. No risk factors could be identified. After uncomplicated childbirth complaints subsided spontaneously in all but one patient within 4 weeks. Recurrence rates in subsequent pregnancies are up to 89%. Conclusion Temporary RLV-induced dilation of the deep inguinal ring in pregnancy is not a common precursor for the development of inguinal hernias later in life. All findings support the theory that the hindrance of venous blood flow caused by the gravid uterus is an important contributing factor for RLV in pregnancy, which is self-limited but has a high risk of recurrence and is not an indication for surgery before or after delivery or for cesarean section.

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Section: Discussionsupporting

confidence: 61%

Is round ligament varicosity in pregnancy a common precursor for the later development of inguinal hernias? The prospective analysis of 28 patients over 9 years

Lechner

Bittner

Borhanian

et al. 2019

Hernia

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“…A primary ventral hernia diagnosed during pregnancy was uncommon: 0·08 per cent in a large register‐based study of more than 20 000 women. None underwent elective or emergency repair during pregnancy.…”

Section: Resultsmentioning

confidence: 99%

EHS and AHS guidelines for treatment of primary ventral hernias in rare locations or special circumstances

et al. 2020

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Background Rare locations of hernias, as well as primary ventral hernias under certain circumstances (cirrhosis, dialysis, rectus diastasis, subsequent pregnancy), might be technically challenging. The aim was to identify situations where the treatment strategy might deviate from routine management. Methods The guideline group consisted of surgeons from the European and Americas Hernia Societies. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used in formulating the recommendations. The Scottish Intercollegiate Guidelines Network (SIGN) critical appraisal checklists were used to evaluate the quality of full‐text papers. A systematic literature search was performed on 1 May 2018 and updated 1 February 2019. The Appraisal of Guidelines for Research and Evaluation (AGREE) instrument was followed. Results Literature was limited in quantity and quality. A majority of the recommendations were graded as weak, based on low quality of evidence. In patients with cirrhosis or on dialysis, a preperitoneal mesh repair is suggested. Subsequent pregnancy is a risk factor for recurrence. Repair should be postponed until after the last pregnancy. For patients with a concomitant rectus diastasis or those with a Spigelian or lumbar hernia, no recommendation could be made for treatment strategy owing to lack of evidence. Conclusion This is the first European and American guideline on the treatment of umbilical and epigastric hernias in patients with special conditions, including Spigelian and lumbar hernias. All recommendations were weak owing to a lack of evidence. Further studies are needed on patients with rectus diastasis, Spigelian and lumbar hernias.

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“…Sí que se han observado una serie de factores de riesgo que influyen en su aparición. Uno de ellos es el embarazo: en este trabajo retrospectivo, se observó un 0.08 % de incidencia de hernia umbilical, y un 0.12 % de hernia inguinal durante la gestación 5,6 . Ello podría deberse a la rápida ganancia y pérdida de peso que distiende los tejidos de la pared abdominal y que durante el proceso podría debilitarlos.…”

Section: Discussionunclassified

Hernia de Spiegel como causa de obstrucción intestinal de íleon en una paciente anticoagulada por fibrilación auricular, abordaje laparoscópico. Reporte de caso.

Rivera¹,

Lotero²,

Uribe³

2019

Rev Hispanoam Hernia

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La Hernia de Spiegel es un tipo de hernia de la pared abdominal poco frecuente. Una vez se diagnostica es conveniente intervenir por el alto riesgo de encarcelación y complicación. A continuación presentamos el caso clínico de una paciente con antecedente de fibrilación auricular anticoagulada con Apixaban; Consultó al servicio de urgencias con signos y síntomas de obstrucción intestinal y se confirmó por tomografía de abdomen la presencia de Hernia de Spiegel izquierda encarcelada. Decidimos esperar 24 horas luego del consumo de anticoagulante para intervenir a la paciente por el alto riesgo de sangrado, la espera podía producir en la paciente una perforación intestinal; por lo que no consideramos oportuno esperar 48 horas sin el consumo de anticoagulante a pesar de ser la recomendación. El abordaje se realizó vía laparoscópica con técnica IPOM, buscábamos evitar sangrados masivos ya que vía laparoscopia se produce un menor trauma en los tejidos. La paciente no presentó complicaciones, tampoco presentó sangrados masivos en la cirugía ni en el postoperatorio. Han transcurrido 13 meses luego de haber sido intervenida y hasta el momento sin reaparición de su hernia.

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Primary ventral or groin hernia in pregnancy: a cohort study of 20,714 women

Abstract: Primary ventral or groin hernia seems rare in pregnancy, and the incidence of emergency repair is extremely low. Watchful waiting strategy is recommended during pregnancy in women suspected for a primary ventral or groin hernia.

Cited by 31 publications

References 16 publications

Is round ligament varicosity in pregnancy a common precursor for the later development of inguinal hernias? The prospective analysis of 28 patients over 9 years

Is round ligament varicosity in pregnancy a common precursor for the later development of inguinal hernias? The prospective analysis of 28 patients over 9 years

EHS and AHS guidelines for treatment of primary ventral hernias in rare locations or special circumstances

Hernia de Spiegel como causa de obstrucción intestinal de íleon en una paciente anticoagulada por fibrilación auricular, abordaje laparoscópico. Reporte de caso.

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