Umbilical Hernia Repair and Pregnancy: Before, during, after…

Cesarean Section (C-Section) and Simultaneous Hernia Repair

Hernia repair during C-section is a common surgical approach. However, these simultaneous surgeries were not well-documented until the 2000s. In 2004, Ochsenbein-Kölble et al. the first case series of simultaneous inguinal or umbilical hernia repairs and C-sections (20) With the informed consent of three patients, a combined surgical procedure was offered to them. In one of them, the umbilical hernia itself served as the indication for a C-section. Compared to C-sections alone, surgery time was longer in cases involving inguinal hernia repair but not umbilical hernia repair. However, Ghnnam et al. reported that compared to a cesarean alone, simultaneous umbilical hernia repair and cesarean required more time (21). They compared 48 patients who underwent a C-section along with the repair of a paraumbilical hernia to 100 patients who underwent a C-section alone. Inpatient periods were similar. Only two patients complained of pain at the umbilicus. The control group needed significantly fewer analgesics. Combined surgery was preferred by all patients. One hernia recurred (2. 8%), following suture repair within 2 years (21). Mesh repairs were free of recurrence.

Gabriele et al. 28 pregnant women who had inguinal or umbilical hernias were reported. These patients were contrasted with 100 patients who underwent a C-section only, as well as concurrent hernia repair (22). Combined procedures took longer than a C-section alone to treat an umbilical and inguinal hernia. Surgeries were uneventful, and no recurrence developed. According to the authors, combining surgeries is safe and prevents readmissions. Also, Jensen et al. after conducting a thorough literature review, they came to the firm conclusion that combining hernia repair with a C-section is the best treatment option (6).

Steinemann et al. recently published a retrospective cohort–control study (23). Using various methods, fourteen patients had umbilical hernias sutured during C-sections. After the Pfannenstiel incision was closed, a paraumbilical semilunar skin incision was used in seven cases to repair external umbilical hernias with sutures. The remaining seven patients underwent suture-assisted internal umbilical hernia repair. Internal suturing required less time than external suturing. Compared to the control group, both strategies extend the time spent in operation. Unfortunately, two recurrences were revealed by ultrasonography in each repair subgroup (28%) The authors recommended mesh repairs in these cases (23).

Interestingly, no patient underwent combined surgery in Haskins et al. ’s most recent review (17). But the paper omits to explain why there haven’t been any instances of simultaneous C-section and hernia repair.

REVIEW article Front. Surg., 29 January 2018 Sec. Visceral Surgery

Umbilical hernias are most common in women than men. Due to gradually increased intra-abdominal pressure, pregnancy may result in herniation or make an already present one obvious. The incidence of umbilical hernia among pregnancies is 0. 08%. The surgical protocol for a pregnant woman with a hernia is not entirely understood. There is disagreement regarding the best time to perform surgery on an umbilical hernia in a woman who is either pregnant or trying to become pregnant. An urgent repair is required if the hernia is imprisoned or strangulated at the time of diagnosis. When a hernia is symptomatic but not complicated, an elective repair should be suggested. It may be preferable to delay the repair of a small, asymptomatic hernia until after the patient gives birth. During pregnancy, there is a high risk of recurrence if the hernia is only repaired with sutures. Repairing an umbilical hernia during pregnancy can be done with little risk to the mother or the unborn child. Second trimester is a proper timing for surgery. At the time of a cesarean section (C-section) or after childbirth, asymptomatic hernias can be repaired. After childbirth, elective repair can begin as soon as the eighth postpartum week. A one-year break can help the patient recover very smoothly, allowing their hormones to stabilize and their body weight to return to normal. Moreover, if the patient wants to have more children, surgery can be delayed for a longer period of time even after another pregnancy. Diastasis recti are very frequent in pregnancy. It may persist in postpartum period. Patients with rectus diastasis are predicted to have a high recurrence risk. This risk is especially high after suture repairs. Mesh repairs should be considered in this situation.

Umbilical hernias are most common in women than men. Because of the gradually rising intra-abdominal pressure, pregnancy may result in an umbilical hernia or make an already present one obvious. Hernia symptoms present in the second trimester in most patients. During the first, second, or third pregnancy, a hernia may be discovered (1). It has been estimated that pregnant women have a 0% chance of developing an umbilical hernia. 08% in a very recent large series (2). However, complicated situations can arise, such as a full-term pregnancy in an umbilical hernia (3), peritonitis brought on by skin ulceration (4), or a pregnant uterus imprisoned within the hernia rims (5).

Although there is currently no clear surgical algorithm for a pregnant woman with a hernia, more recent and superior scientific evidence has accumulated (1, 2, 6) There is disagreement regarding the best time to perform surgery on an umbilical hernia in a woman who is expecting or intends to become pregnant. In actuality, these two categories of cases should be considered separately. Hernias that are symptomless or have minor symptoms, such as slight discomfort or pain, should be regularly examined and treated electively after delivery and uterine involution, according to Augustin and Majerovic (7). In the adult population, it has recently been demonstrated that watchful waiting, even for up to 5 years, appears to be a secure method for ventral hernias (8).

The cases should be divided into a number of scenarios in order to better understand the connection between umbilical hernia and pregnancy. In fact, addressing the problem case-by-case might be the best course of action.

How Long Does It Take For Full Recovery?

After a laparoscopic procedure, you might be able to walk, but it might take three weeks before you can resume your other physical activities. You could require one to two weeks of rest (6). In the case of open surgery, the recovery period is longer. During your recovery period, you should refrain from strenuous activities, lifting objects that are heavy, and climbing stairs.

HERNIA REPAIR WITH MESH 3 MONTHS POSTPARTUM | BEFORE AND AFTER PICS

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