Danawar Nuaman A, Mekaiel Andrew, Raut Sumit, Reddy Ishani, Malik Bilal Haider
General Surgery, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA.
Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA.
Cureus. 2020 Jul 2;12(7):e8959. doi: 10.7759/cureus.8959.
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. The lack of an agreement about the treatment of ventral hernias in fertile women makes the decision to treat and the process challenging. The treatment significantly depends on two factors: the symptoms and the pregnancy status at diagnosis. If the hernia is incarcerated or strangulated at presentation, an emergency repair is obligatory. If the hernia is symptomatic, but not complicated, elective surgery should be offered. The timing of repair will depend on whether the patient is already pregnant or non-pregnant. In pregnant patients, if the hernia is small and asymptomatic, it may be better to delay the surgery until after delivery or after the last pregnancy. If the hernia is symptomatic and seems to affect the patient's quality of life, it may be better to postpone the repair until the second trimester or after delivery if complications do not occur. 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). In pre-pregnancy patients, if the hernia is large and symptomatic, it may be better to do an elective repair and then wait for one or two years before the next pregnancy. However, if the hernia is small or minimally symptomatic, it may be better to hold the repair until after delivery or after the last pregnancy. Pregnancy may be considered a significant risk factor for hernia recurrence. The laparoscopic mesh repair should be offered whenever possible, whereas the open approach may be preferred in complicated cases. The suture repair may be suitable for both small hernias and in cases of gross contamination.
疝气是一种常见的外科问题。虽然孕期疝气并不常见，但如果出现，对外科医生和患者来说都具有挑战性。迄今为止，医学界对于孕妇疝气的择期修复尚无共识。争论主要集中在三个方面：时机、方法和手术技术。本研究旨在基于现有最佳数据，为该领域提供一条清晰的路径。在本研究中，我们收集了2010年至2020年发表在PubMed上的英文综述（有三篇2010年之前发表的文章因包含相关信息而被保留）。我们使用了常规关键词和医学主题词（MeSH）。两位作者对收集到的研究进行筛选，以选出最符合我们综述纳入标准的文章。本次综述所考虑的文章可分为回顾性研究、病例报告和综述。未发现随机对照试验。对于育龄期女性腹疝治疗缺乏共识，使得治疗决策和过程颇具挑战性。治疗很大程度上取决于两个因素：症状和诊断时的妊娠状态。如果疝气在就诊时发生嵌顿或绞窄，必须进行急诊修复。如果疝气有症状但未并发其他情况，应提供择期手术。修复时机将取决于患者是已怀孕还是未怀孕。对于孕妇，如果疝气小且无症状，最好将手术推迟到分娩后或最后一次妊娠之后。如果疝气有症状且似乎影响患者生活质量，若未出现并发症，最好将修复推迟到孕中期或分娩后。对于接受过腹腔镜Roux-en-Y胃旁路术（LRYGB）的孕妇，应怀疑腹内疝（IH）是腹痛的原因。对于孕前患者，如果疝气大且有症状，最好进行择期修复，然后等待一两年再进行下一次妊娠。然而，如果疝气小或症状轻微，最好推迟修复直到分娩后或最后一次妊娠之后。妊娠可能被视为疝气复发的一个重要危险因素。只要有可能，应采用腹腔镜补片修补术，而在复杂病例中可能更倾向于开放手术方式。缝线修补术可能适用于小疝气以及污染严重的情况。
