Management of hernias in pregnancy

Even though groin and umbilical hernias are rare in adult women, the rarer cases of pregnant women presenting with hernias create distinct challenges to treatment planning. The course of hernias in pregnant women, the effect of hernias on delivery, and the timing of elective herniorrhaphy have not been established. To date, there have been no published series establishing that postpartum repair of umbilical and groin hernias that develop in pregnancy is safe and acceptable.

From September 2004 to July 2006, 12 female patients with groin or umbilical hernias occurring during pregnancy presented to a single surgeon at the Mount Sinai Medical Center. All patients later underwent postpartum herniorrhaphy and were enrolled retrospectively. All patients underwent either open umbilical or inguinal hernia repair primarily or using a plug-and-patch method (Bard Mesh PerFix Plug; Davol) in an ambulatory setting. Mean longterm followup was 17 months.

Mean age of the patients was 35 years (range 27 to 41 years). The most common type of hernia was inguinal (58%). The predominant side was right (86%). None of the patients had an associated diagnosis or clinically significant medical history. All patients were evaluated, operated, and followed up by the same surgeon. Neither incarceration nor strangulation occurred in any patient before or after delivery. None required hospitalization or emergent hernia repair. Patients did not experience any delivery complications. All patients underwent elective postpartum open hernia repair with sedation and local anesthesia (4 to 52 weeks postpartum; mean 22 weeks postpartum). No patient experienced any perioperative or postoperative complications. None of the patients experienced a hernia recurrence. Four patients had subsequent uncomplicated pregnancies.

This series lends support to the "watchful waiting" strategy during pregnancy, with a plan for postpartum herniorrhaphy. Elective, postpartum hernia repair provides similar results to the nonpregnant population.