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Abdominal wall hernia and pregnancy: a systematic review

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Abstract

Purpose

There is no consensus as to the treatment strategy for abdominal wall hernias in fertile women. This study was undertaken to review the current literature on treatment of abdominal wall hernias in fertile women before or during pregnancy.

Methods

A literature search was undertaken in PubMed and Embase in combination with a cross-reference search of eligible papers.

Results

We included 31 papers of which 23 were case reports. In fertile women undergoing sutured or mesh repair, pain was described in a few patients during the last trimester of a subsequent pregnancy. Emergency surgery of incarcerated hernias in pregnant women, as well as combined hernia repair and cesarean section appears as safe procedures. No major complications were reported following hernia repair before or during pregnancy. The combined procedure of elective cesarean section and abdominal wall hernia repair was reported in 102 patients without major complications.

Conclusions

The literature on abdominal wall hernia and pregnancy is sparse. Abdominal wall hernia repair with suture or mesh may cause pain in the last trimester of a subsequent pregnancy. Hernia repair in conjunction with cesarean section appear as the optimal treatment of a pregnant patient with a symptomatic abdominal wall hernia.

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References

  1. Choi JJ, Palaniappa NC, Dallas KB, Rudich TB, Colon MJ, Divino CM (2012) Use of mesh during ventral hernia repair in clean-contaminated and contaminated cases: outcomes of 33,832 cases. Ann Surg 255:176–180

    Article  PubMed  Google Scholar 

  2. den Hartog D, Dur AH, Tuinebreijer WE, Kreis RW (2008) Open surgical procedures for incisional hernias. Cochrane Database Syst Rev: CD006438

  3. Junge K, Klinge U, Prescher A, Giboni P, Niewiera M, Schumpelick V (2001) Elasticity of the anterior abdominal wall and impact for reparation of incisional hernias using mesh implants. Hernia 5:113–118

    Article  CAS  PubMed  Google Scholar 

  4. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6:e1000097

    Article  Google Scholar 

  5. Aaen V, Cowan L, Sakala EP, Small ML (1993) Prolonged parenteral meperidine analgesia during pregnancy for pain from an abdominal wall mesh graft. Obstet Gynecol 82:721–722

    CAS  PubMed  Google Scholar 

  6. Buch KE, Tabrizian P, Divino CM (2008) Management of hernias in pregnancy. J Am Coll Surg 207:539–542

    Article  PubMed  Google Scholar 

  7. Schoenmaeckers E, Stirler V, Raymakers J, Rakic S (2012) Pregnancy following laparoscopic mesh repair of ventral abdominal wall hernia. JSLS 16:85–88

    Article  PubMed Central  PubMed  Google Scholar 

  8. Abrahamson J, Gorman J (2000) Pregnancy and ventral hernia repair. Hernia 4:187–191

    Article  Google Scholar 

  9. Ehigiegba AE, Selo-Ojeme DO (1999) Myomectomy in pregnancy: incarcerated pedunculated fibroid in an umbilical hernia sac. Int J Clin Pract 53:80

    CAS  PubMed  Google Scholar 

  10. Uludag M, Yetkin G, Demirel M, Citgez B, Isgor A (2006) Incarceration of umbilical hernia during pregnancy due to a sessile fibroid. Hernia 10:357–359

    Article  CAS  PubMed  Google Scholar 

  11. Seims AD, Lube MW (2009) Incarceration of a sessile uterine fibroid in an umbilical hernia during pregnancy. Hernia 13:309–311

    Article  CAS  PubMed  Google Scholar 

  12. Wong C (2005) A uterine fibroid presenting as an incarcerated umbilical hernia during pregnancy. Hernia 9:298–299

    Article  CAS  PubMed  Google Scholar 

  13. Perry Z, Netz U, Yitzhak A, Mizrahi S (2011) Pros and cons in the approach to an incarcerated umbilical hernia in the pregnant woman. Am Surg 77:E43–E44

    PubMed  Google Scholar 

  14. Ahmed A, Stephen G, Ukwenya Y (2011) Spontaneous rupture of umbilical hernia in pregnancy: a case report. Oman Med J 26:285–287

    Article  PubMed Central  PubMed  Google Scholar 

  15. Zalel Y, Shalev E, Romano S, Ben-Ami M, Dan U, Weiner E (1992) Incarcerated Spigelian hernia in pregnancy: an ultrasonic diagnosis. J Clin Ultrasound 20:146–148

    Article  CAS  PubMed  Google Scholar 

  16. Udare AS, Bhalekar PS, Mondel PK (2013) Sonographic diagnosis of incarcerated Spigelian hernia during pregnancy. Int J Gynaecol Obstet 120:284–285

    Article  PubMed  Google Scholar 

  17. Limjoco UR, Grubbs JM, Thomas MD (1998) Richter’ hernia with bowel perforation. Am Fam Physician 58(352):354

    Google Scholar 

  18. Wai PY, Ruby JA, Davis KA, Roberts AC, Roberts KE (2009) Laparoscopic ventral hernia repair during pregnancy. Hernia 13:559–563

    Article  CAS  PubMed  Google Scholar 

  19. Martin LF, Barry MG, Peeno DO, Fry DE (1985) Abdominal wall repair with polypropylene mesh in pregnancy. Obstet Gynecol 66:141–143

    CAS  PubMed  Google Scholar 

  20. Deka D, Banerjee N, Takkar D (2000) Incarcerated pregnant uterus in an incisional hernia. Int J Gynaecol Obstet 70:377–379

    Article  CAS  PubMed  Google Scholar 

  21. Altchek A, Rudick J (1987) Preperitoneal herniorrhaphy: adjunct to cesarean section. Obstet Gynecol 70:470–471

    CAS  PubMed  Google Scholar 

  22. Ochsenbein-Kolble N, Demartines N, Ochsenbein-Imhof N, Zimmermann R (2004) Cesarean section and simultaneous hernia repair. Arch Surg 139:893–895

    Article  PubMed  Google Scholar 

  23. Gabriele R, Conte M, Izzo L, Basso L (2010) Cesarean section and hernia repair: simultaneous approach. J Obstet Gynaecol Res 36:944–949

    Article  PubMed  Google Scholar 

  24. Ghnnam WM, Helal AS, Fawzy M, Ragab A, Shalaby H, Elrefaay E (2009) Paraumbilical hernia repair during cesarean delivery. Ann Saudi Med 29:115–118

    Article  PubMed Central  PubMed  Google Scholar 

  25. Steinemann DC, Limani P, Ochsenbein N, Krahenmann F, Clavien PA, Zimmermann R, Hahnloser D (2013) Suture repair of umbilical hernia during caesarean section: a case–control study. Hernia 17:521–526

    Article  CAS  PubMed  Google Scholar 

  26. Saha PK, Rohilla M, Prasad GR, Dhaliwal LK, Gupta I (2006) Herniation of gravid uterus: report of 2 cases and review of literature. MedGenMed 8:14

    PubMed Central  PubMed  Google Scholar 

  27. Palazzo F, Ragazzi S, Ferrara D, Piazza D (2010) Herniated gravid uterus through an incisional hernia treated with the component separation technique. Hernia 14:101–104

    Article  CAS  PubMed  Google Scholar 

  28. Mbuagbaw LC, Morfaw FL (2012) Gravid uterus in an umbilical hernia. Case Rep Obstet Gynecol 2012:439489

    PubMed Central  PubMed  Google Scholar 

  29. Punguyire D, Iserson KV, Apanga S (2011) Full-term pregnancy in umbilical hernia. Pan Afr Med J 8:6

    PubMed Central  PubMed  Google Scholar 

  30. Sahu L, Bupathy A (2006) Evisceration of pregnant uterus through the incisional hernia site. J Obstet Gynaecol Res 32:338–340

    Article  PubMed  Google Scholar 

  31. Young BC, Fugelso D, Takoudes T (2009) Incisional hernia with bowel incarceration and obstruction at 34 weeks gestational age. Arch Gynecol Obstet 279:905–907

    Article  PubMed  Google Scholar 

  32. Banerjee N, Deka D, Sinha A, Prasrad R, Takkar D (2001) Gravid uterus in an incisional hernia. J Obstet Gynaecol Res 27:77–79

    Article  CAS  PubMed  Google Scholar 

  33. Agrawal S, Madan M, Kumari R, Gaikwad H, Raghunandan C, Leekha N, Ghuliani M (2010) Gravid uterus as a content of anterior abdominal wall incisional hernia. J Obstet Gynaecol 30:518–519

    Article  CAS  PubMed  Google Scholar 

  34. Rao RS, Shankaregowda HS (2006) A case of herniated gravid uterus through a laparotomy scar. Indian J Med Sci 60:154–157

    Article  PubMed  Google Scholar 

  35. Malhotra M, Sharma JB, Wadhwa L, Arora R (2003) Successful pregnancy outcome after cesarean section in a case of gravid uterus growing in an incisional hernia of the anterior abdominal wall. Indian J Med Sci 57:501–503

    CAS  PubMed  Google Scholar 

  36. Kim WB, Kim J, Boo YJ, Park SH, Song TJ, Suh SO (2009) Successful vaginal delivery following laparoscopic abdominal wall reconstruction in an adult survivor of an omphalocele without prior surgical repair: report of a case. Hernia 13:431–434

    Article  CAS  PubMed  Google Scholar 

  37. Christoffersen MW, Helgstrand F, Rosenberg J, Kehlet H, Bisgaard T (2013) Lower reoperation rate for recurrence after mesh versus sutured elective repair in small umbilical and epigastric hernias. A nationwide register study. World J Surg 37:2548–2552

    Article  CAS  PubMed  Google Scholar 

  38. Simchen E, Wax Y, Galai N, Israeli A (1992) Differential effect of risk factors on early and late wound infections in patients undergoing herniorrhaphies. Ann Epidemiol 2:263–272

    Article  CAS  PubMed  Google Scholar 

  39. Liem MS, van der Graaf Y, Zwart RC, Geurts I, van Vroonhoven TJ (1997) Risk factors for inguinal hernia in women: a case–control study. The Coala Trial Group. Am J Epidemiol 146:721–726

    Article  CAS  PubMed  Google Scholar 

  40. Ruhl CE, Everhart JE (2007) Risk factors for inguinal hernia among adults in the US population. Am J Epidemiol 165:1154–1161

    Article  PubMed  Google Scholar 

  41. Rosemar A, Angeras U, Rosengren A (2008) Body mass index and groin hernia: a 34-year follow-up study in Swedish men. Ann Surg 247:1064–1068

    Article  PubMed  Google Scholar 

  42. Debrah SA, Okpala AM (2013) Epigastric hernia in pregnancy: a management plan based on a systematic review of literature and a case history. Indian J Surg 75:212–213

    Article  PubMed Central  PubMed  Google Scholar 

  43. Mayer IE, Hussain H (1998) Abdominal pain during pregnancy. Gastroenterol Clin North Am 27:1–36

    Article  CAS  PubMed  Google Scholar 

  44. Vikanes AV, Stoer NC, Magnus P, Grjibovski AM (2013) Hyperemesis gravidarum and pregnancy outcomes in the Norwegian mother and child cohort—a cohort study. BMC Pregnancy Childbirth 13:169

    Article  PubMed Central  PubMed  Google Scholar 

  45. Shetty MK (2010) Abdominal computed tomography during pregnancy: a review of indications and fetal radiation exposure issues. Semin Ultrasound CT MR 31:3–7

    Article  PubMed  Google Scholar 

  46. IJpma FF, Boddeus KM, de Haan HH, van Geldere D (2009) Bilateral round ligament varicosities mimicking inguinal hernia during pregnancy. Hernia 13:85–88

    Article  CAS  PubMed  Google Scholar 

  47. Lechner M, Fortelny R, Ofner D, Mayer F (2014) Suspected inguinal hernias in pregnancy—handle with care! Hernia 18:375–379

    Article  CAS  PubMed  Google Scholar 

  48. Johnson A, Young D, Reilly J (2006) Caesarean section surgical site infection surveillance. J Hosp Infect 64:30–35

    Article  CAS  PubMed  Google Scholar 

  49. Aabakke AJ, Krebs L, Ladelund S, Secher NJ (2014) Incidence of incisional hernia after cesarean delivery: a register-based cohort study. PLoS One 9:e108829

    Article  PubMed Central  PubMed  Google Scholar 

  50. Mikkelsen T, Bay-Nielsen M, Kehlet H (2002) Risk of femoral hernia after inguinal herniorrhaphy. Br J Surg 89:486–488

    Article  CAS  PubMed  Google Scholar 

  51. Mazze RI, Kallen B (1991) Appendectomy during pregnancy: a Swedish registry study of 778 cases. Obstet Gynecol 77:835–840

    CAS  PubMed  Google Scholar 

  52. Sadot E, Telem DA, Arora M, Butala P, Nguyen SQ, Divino CM (2010) Laparoscopy: a safe approach to appendicitis during pregnancy. Surg Endosc 24:383–389

    Article  PubMed  Google Scholar 

  53. Affleck DG, Handrahan DL, Egger MJ, Price RR (1999) The laparoscopic management of appendicitis and cholelithiasis during pregnancy. Am J Surg 178:523–529

    Article  CAS  PubMed  Google Scholar 

  54. Visser BC, Glasgow RE, Mulvihill KK, Mulvihill SJ (2001) Safety and timing of nonobstetric abdominal surgery in pregnancy. Dig Surg 18:409–417

    Article  CAS  PubMed  Google Scholar 

  55. Kuczkowski KM (2006) The safety of anaesthetics in pregnant women. Expert Opin Drug Saf 5:251–264

    Article  CAS  PubMed  Google Scholar 

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Conflict of interest

KJ, NH and LJ declare no conflict of interest.

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Correspondence to K. K. Jensen.

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Jensen, K.K., Henriksen, N.A. & Jorgensen, L.N. Abdominal wall hernia and pregnancy: a systematic review. Hernia 19, 689–696 (2015). https://doi.org/10.1007/s10029-015-1373-6

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  • DOI: https://doi.org/10.1007/s10029-015-1373-6

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