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

Abstract

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.

Hernia in pregnancy—Does it matter?

“…Mesh placement has been shown, even in small ventral hernias with fascial defect <2 cm, to reduce likelihood of recurrence especially during subsequent pregnancy but is associated with higher chance of chronic post‐operative pain 13 and post‐operative wound infection. Others suggest that mesh placement is not associated with significant impact on subsequent pregnancies and labour course itself 14,15 . Our standard practice is mesh placement in large umbilical or paraumbilical hernias larger than 2 cm.…”

Inguinal Hernia in Nonhuman Primates: From Asymptomatic to Life-Threatening Events

“…Watchful waiting is accepted in case of an asymptomatic reducible groin mass based on RLVs. Postpartum, when pelvic venous obstruction by the gravid uterus is relieved, spontaneous resolution occurs in most patients [78]. In case of a symptomatic reducible groin mass, duplex sonography is advised, as it helps in differentiating RLV from other causes of inguinal swelling in pregnancy, thus avoiding unnecessary surgical exploration [73,79].…”

How to Treat Hernias in Pregnant Women?

“…Regarding groin hernia during pregnancy, it does not require routine repair [14]. Round ligament varicosities (RLV) are a common differential diagnosis of groin hernia, and they usually disappear within two to four weeks after delivery [15]. The recurrence rate of ventral hernias in women of reproductive age is about 12% [12].…”

“…However, another study revealed that mesh repair was not associated with a reduction in the recurrence risk [26]. The mesh repair of ventral hernia and inguinal hernias appears to be a safe approach with no significant impact on pregnancy and labor course [15,24,27]. During pregnancy, suture repair may increase the risk of recurrence.…”