How to Treat Hernias in Pregnant Women?

Abstract

A hernia is a common surgical problem. Although hernias during pregnancy are uncommon, they can be challenging for both the surgeon and the patient if present. To date, there is no consensus in the medical community regarding the elective repair of hernias in pregnant women. The debate mainly concerns three areas: the timing, the approach, and the surgical technique. This study aims to offer a clear pathway in this field based on the best available data. In this study, we collected reviews written in English and published in PubMed from 2010 to 2020 (the exception being three articles that were published before 2010, which we retained since they contained relevant information). We used regular and Medical Subject Headings (MeSH) keywords. Two of the authors screened the collected studies to select the best articles that would fit our inclusion criteria for the review. The articles considered for this review can be classified into retrospective studies, case reports, and reviews. No randomized controlled trials were found.

A multicenter retrospective case–cohort study on the prevalence of incisional morbidities in late pregnant mares following exploratory celiotomy (2014–2019): 579 cases

“…Incisional dehiscence following colic surgery has been reported, 5 and risk factors for hernia, including weight of the gravid uterus and age‐related degenerative changes, have been postulated 6 . Similar hernia risks have been reported in pregnant women in addition to documented increased intraabdominal pressures and alterations in the rectus abdominus muscle as pregnancy progresses 7,8 . Further concerns include the inability to provide an abdominal press due to reduced abdominal muscle strength or pain associated with a healing incision, or an increased risk of dystocia associated with fetal malposition or malpresentation 4…”

“…6 Similar hernia risks have been reported in pregnant women in addition to documented increased intraabdominal pressures and alterations in the rectus abdominus muscle as pregnancy progresses. 7,8 Further concerns include the inability to provide an abdominal press due to reduced abdominal muscle strength or pain associated with a healing incision, or an increased risk of dystocia associated with fetal malposition or malpresentation. 4 In pregnant women, nonobstetrical surgeries are recommended in the second trimester or following parturition as surgeries in the first or third trimester can lead to difficulties for the duration of gestation and increase the risk of fetal hypoxia.…”

“…4 In pregnant women, nonobstetrical surgeries are recommended in the second trimester or following parturition as surgeries in the first or third trimester can lead to difficulties for the duration of gestation and increase the risk of fetal hypoxia. [7][8][9] However, a delay or nonperformance of an emergency surgery in women has been associated with increased hospitalizations, higher miscarriage rates, premature rupture of membranes, and preterm births. [10][11][12] Studies in rats found that pregnant rats had a lower incisional bursting strength and overall weakness than nonpregnant rats with healing laparotomy incisions.…”

Incisional Hernia Repair During Cesarean Section

“…Currently, there is no consensus on the optimal timing or treatment technique for a gravida with a large or symptomatic hernia [3]. The lack of an agreement on the treatment of ventral hernias in pregnant women makes the decision to treat and the process challenging.…”

“…However, if there is an asymptomatic hernia in a pregnant patient, the repair is often delayed until completed childbearing in order to decrease recurrence in future pregnancies. However, if the patient is suffering from symptoms and unhappy with their quality of life due to her symptoms, a repair can be done during pregnancy but postponed until at least after the second trimester when organogenesis is completed [3][4].…”