, Volume 22, Issue 6, pp 1067–1075 | Cite as

Ventral hernia recurrence in women of childbearing age: a systematic review and meta-analysis

  • T. Nouh
  • F. S. Ali
  • K. J. Krause
  • I. Zaimi



There is no consensus agreement on the optimal management strategy for ventral hernia in women of childbearing age. The theoretical increased risk of ventral hernia recurrence can impact management strategies. We conducted a systematic review of the literature to report the ventral hernia recurrence rate in women of childbearing age who underwent hernia repair prior to their pregnancy and propose a management algorithm.


We systematically searched multiple databases including MEDLNE, PubMed, and the Cochrane Library sources from inception to August, 2017. Two reviewers independently identified 314 primary studies, assessed methodological quality, and extracted data. Quality of included studies was assessed by employing the Newcastle Ottawa quality assessment tool for cohort studies. A separate tool was utilized for assessing the methodological quality of case series. A meta-analysis of proportions was conducted of studies reporting incidence of recurrence using STATA, employing a random effects model, to calculate a pooled weighted incidence rate (with 95% confidence interval). Descriptive statistics were employed to report the findings of studies which did not report any ventral hernia recurrence.


Five retrospective studies were included in our review, enrolling a total of 14,638 female participants. Upon stratifying patients according to pregnancy status after primary hernia repair, 13,494 were found to be in the non-pregnant cohort whereas 1,144 were included in the pregnant cohort. Overall, 9% (95% CI 8–9%) of the non-pregnant patients experienced a recurrence whereas 12% (95% CI 10–15%) of patients that became pregnant subsequent to a ventral hernia repair experienced a recurrence. No major adverse events were recorded throughout the course of pregnancy.


Ventral hernias in women of childbearing age have a pooled recurrence rate of 12%. Pregnancy may be considered a risk factor for ventral hernia recurrence. Female patients of childbearing age with asymptomatic or minimally symptomatic ventral hernias that do not pose a significant strain on the patients’ quality of life could be provided with the option of watchful waiting, with appropriate education of risks while discussing management.


Pregnancy Hernia Recurrence Watchful waiting Surgery 



Nothing to report.

Compliance with ethical standards

Conflict of interest

TN, FSA, KJK, and IZ declare no conflict of interest.

Ethical approval

For this type of study institutional review is not required.

Human and animal rights

The authors did not perform any studies on human participants or animals in this article.

Informed consent

For this type of study formal consent is not required.


  1. 1.
    Bedewi MA, El-Sharkawy MS, Al Boukai AA, Al-Nakshabandi N (2012) Prevalence of adult paraumbilical hernia. Assessment by high-resolution sonography: a hospital-based study. Hernia J Hernias Abdom Wall Surg 16(1):59–62. CrossRefGoogle Scholar
  2. 2.
    den Hartog D, Dur AH, Tuinebreijer WE, Kreis RW (2008) Open surgical procedures for incisional hernias. In: Tuinebreijer WE (ed) Cochrane database of systematic reviews. Wiley, Chichester, p CD006438. CrossRefGoogle Scholar
  3. 3.
    Kokotovic D, Sjølander H, Gögenur I, Helgstrand F (2016) Watchful waiting as a treatment strategy for patients with a ventral hernia appears to be safe. Hernia 20(2):281–287. CrossRefPubMedGoogle Scholar
  4. 4.
    Oma E, Bay-Nielsen M, Jensen KK, Jorgensen LN, Pinborg A, Bisgaard T (2017) Primary ventral or groin hernia in pregnancy: a cohort study of 20,714 women. Hernia 21(3):335–339. CrossRefPubMedGoogle Scholar
  5. 5.
    Jensen KK, Henriksen NA, Jorgensen LN (2015) Abdominal wall hernia and pregnancy: a systematic review. Hernia 19(5):689–696. CrossRefPubMedGoogle Scholar
  6. 6.
    Liem MSL, van der Graaf Y, Zwart RC, Geurts I, van Vroonhoven TJMV (1997) Risk factors for inguinal hernia in women: a case-control study. Am J Epidemiol 146(9):721–726. CrossRefPubMedGoogle Scholar
  7. 7.
    Morton S, Berg A, Levit L, Eden J (eds) (2011) Finding what works in health care: standards for systematic reviews. National Academies PressGoogle Scholar
  8. 8.
    Moher D, Liberati A, Tetzlaff J, Altman DG, Group TP (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6(7):e1000097. CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Murad MH, Sultan S, Haffar S, Bazerbachi F (2018) Methodological quality and synthesis of case series and case reports. BMJ Evid Based Med 23(2):60–63. CrossRefPubMedGoogle Scholar
  10. 10.
    Lappen JR, Sheyn D, Hackney DN (2016) Does pregnancy increase the risk of abdominal hernia recurrence after prepregnancy surgical repair? Am J Obstet Gynecol 215(3):390.e391–390.e395Google Scholar
  11. 11.
    Oma E, Jensen KK, Jorgensen LN (2017) Increased risk of ventral hernia recurrence after pregnancy: a nationwide register-based study. Am J Surg 214(3):474–478. CrossRefPubMedGoogle Scholar
  12. 12.
    Buch KE, Tabrizian P, Divino CM (2008) Management of hernias in pregnancy. J Am Coll Surg 207(4):539–542. CrossRefPubMedGoogle Scholar
  13. 13.
    Schoenmaeckers E, Stirler V, Raymakers J, Rakic S (2012) Pregnancy following laparoscopic mesh repair of ventral abdominal wall hernia. JSLS J Soc Laparoendosc Surg 16(1):85–88. CrossRefGoogle Scholar
  14. 14.
    Abrahamson J, Gorman J (2000) Pregnancy and ventral hernia repair. Hernia 4(4):187–191. CrossRefGoogle Scholar
  15. 15.
    Ahmed A, Stephen G, Ukwenya Y (2011) Spontaneous rupture of umbilical hernia in pregnancy: a case report. Oman Med J 26(4):285–287. CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Exarchos G, Vlahos N, Dellaportas D, Metaxa L, Theodosopoulos T (2017) Incarcerated giant uterine leiomyoma within an incisional hernia: a case report. Clin Case Rep. CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Uludag M, Yetkin G, Demirel M, Citgez B, Isgor A (2006) Incarceration of umbilical hernia during pregnancy due to a sessile fibroid. Hernia 10(4):357–359. CrossRefPubMedGoogle Scholar
  18. 18.
    Serra AE, Fong A, Chung JH (2014) A gut-wrenching feeling. Am J Obstet Gynecol 211(1):79.e1–79.e2. CrossRefGoogle Scholar
  19. 19.
    Gabriele R, Conte M, Izzo L, Basso L (2010) Cesarean section and hernia repair: simultaneous approach. J Obstet Gynaecol Res 36(5):944–949. CrossRefPubMedGoogle Scholar
  20. 20.
    Ochsenbein-Kölble N (2004) Cesarean section and simultaneous hernia repair. Arch Surg 139(8):893. CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Trauma and Acute Care Surgery Unit, Department of Surgery, College of MedicineKing Saud UniversityRiyadhKingdom of Saudi Arabia
  2. 2.Department of Internal MedicinePresence Saint Joseph HospitalChicagoUSA
  3. 3.Research Medical LibraryThe University of Texas MD Anderson Cancer CenterHoustonUSA
  4. 4.Department of SurgeryErasmus MCRotterdamThe Netherlands

Personalised recommendations