Umbilical hernia repair in women of childbearing age

Susan Maurer¹, Savannah Renshaw¹, Li-Ching Huang², Carla Holcomb¹, Noah Switzer¹, Courtney Collins¹, Vimal Narula¹, Benjamin Poulose¹. ¹The Ohio State University, ²Vanderbilt University

Introduction: Women of childbearing age represent a unique challenge to hernia surgery, particularly for umbilical hernias secondary to physiologic changes associated with pregnancy. Thus far, no consensus has been developed for the most appropriate way to approach umbilical hernia repair in women aged 18-45. This study looks to try to understand the current management of this patient population and outcomes associated with these management decisions.

Methods: A retrospective review of prospectively collected data was conducted in women aged 18-45 with umbilical hernia repair using the Americas Hernia Society Quality Collaborative. Recurrence rate and abdominal wall function, based on the HerQLes assessment tool, at both 30 days and 1 year were determined for open repair versus laparoscopic repair. The impact of mesh use on recurrence was also evaluated in the open repair group.

Results: A total of 510 women were identified, with 479 (93.9%) undergoing open repair (OUHR) and 71 undergoing laparoscopic repair (LUHR). The LUHR group included patients with higher BMI, ASA class, hernia size and hernia grade. Within the open hernia repair group, 247 patients were repaired primarily and 192 were repaired with mesh. Recurrence rate at 30 days in the OUHR group was 0.004%, while recurrence was 3% in the LUHR group (p=0.036). Fifty-one patients had completed 1 year follow-up, 16% of those patients in the OUHR group were found to have a recurrence, while 0% of the LUHR group were found to have a recurrence (p=0.3). Within the OUHR group, 1% of the primary repairs and 0% of the mesh repairs had recurred at 30 days (p=0.21). At 1 year (n=45), this was found to be 17% and 12%, respectively (p=0.67). At 1 year, 32 patients had completed the HerQLes assessment tool. Those in the LUHR group trended toward a higher summary score (p=0.15), and therefore higher quality of life after their UHR.

Conclusions: While there are many patient factors that are considered when determining which type of umbilical hernia repair, the ideal repair of women of childbearing age has not yet been elucidated. The AHSQC database shows that most surgeons elect to perform an open primary repair and with 30 day recurrence rates this seems to be the appropriate choice; however, at 1 year, the recurrence rate is less in the laparoscopic repair group.