From the Guidelines
Pregnancy hernias require immediate medical attention if symptoms like severe pain, vomiting, or inability to reduce the hernia occur, as delays in treatment can lead to high incidence of maternal and fetal death 1. When considering the management of hernias during pregnancy, it's essential to prioritize the risks and symptoms associated with internal herniation, as reported in a systematic review that found all maternal and perinatal deaths in pregnancies complicated by internal herniation after Roux-en-Y gastric bypass (RYGB) occurred in women treated later than 48 hours after symptom onset 1.
Key Considerations
- Herniation can occur in the same pregnancy even after previous closure of mesenteric defects, with the most common location being Petersen's space 1.
- Gastric band slippage may be increased during pregnancy due to vomiting and increased intraabdominal pressure, with an incidence of 12% during pregnancy compared with 3% to 5% in the general adjustable gastric band (AGB) population 1.
- A shorter time interval between AGB and pregnancy was associated with a higher rate of primary band revisions after pregnancy 1.
Management Approach
- Patients should be advised about the risks and symptoms of internal herniation and should seek appropriate medical assistance without delay 1.
- Conservative management, including rest, avoiding heavy lifting, and wearing supportive garments, is typically recommended unless complications arise.
- Surgery is usually postponed until after delivery unless the hernia becomes strangulated or incarcerated, which requires emergency intervention.
Post-Pregnancy Considerations
- After pregnancy, surgical repair may be considered if the hernia persists, typically using mesh reinforcement under general anesthesia.
- Recovery takes 2-6 weeks depending on the repair technique.
From the Research
Pregnancy Hernia Overview
- A hernia is a common surgical problem that can be challenging for both the surgeon and the patient during pregnancy 2.
- The treatment of hernias in pregnant women depends on two factors: the symptoms and the pregnancy status at diagnosis 2, 3.
Diagnosis and Management
- If the hernia is incarcerated or strangulated at presentation, an emergency repair is obligatory 2.
- If the hernia is symptomatic, but not complicated, elective surgery should be offered 2.
- The timing of repair will depend on whether the patient is already pregnant or non-pregnant 2, 4.
- Laparoscopic mesh repair should be offered whenever possible, whereas the open approach may be preferred in complicated cases 2, 4.
Considerations for Pregnant Women
- Pregnancy may be considered a significant risk factor for hernia recurrence 2.
- Internal herniation (IH) should be suspected as a cause of the abdominal pain in pregnant women who have undergone laparoscopic Roux-en-Y gastric bypass (LRYGB) 2.
- Elective procedures should be delayed until after delivery and all semi-elective surgeries until organogenesis is completed during the second trimester 4.
Surgical Approaches
- Laparoscopic ventral hernia repair can be safe during pregnancy with appropriate fetal monitoring and consideration of physiologic changes that occur during parturition 4.
- The approach is strictly individualized and depends on two main and important factors: the state of emergency and the gestational week of the pregnancy 3.
- Watchful waiting is not recommended in patients with symptomatic hernias or in nonpregnant women 5.