Skip to main content

Dealing with the round ligament of uterus in laparoscopic groin hernia repair: a nationwide survey among experienced surgeons

Abstract

Purpose

Our aim was to investigate how often a national cohort of experienced groin hernia surgeons transected the round ligament of uterus in laparoscopic groin hernia repair. Furthermore, we wished to explore the surgeons’ personal opinions and knowledge on the function and importance of the ligament.

Methods

An electronic questionnaire was sent to all surgeons in Denmark performing laparoscopic groin hernia repair on a regular basis. The questionnaire consisted of demographic details, estimated incidence of transection of the round ligament of uterus, information about transection to the patients, documentation of transection in the medical records, and the surgeons’ personal opinions and knowledge of the importance of the ligament.

Results

A total of 71 surgeons met our eligibility criteria and 61 (86%) provided complete responses. We estimated that the round ligament of uterus was transected in 395 of 813 (49%) herniorrhaphies during the past 12 months. Personal opinions and knowledge on the function of the ligament and the importance of preserving it varied greatly among the surgeons.

Conclusions

Transection of the round ligament of uterus in laparoscopic groin hernia repair is common. The consequences of transecting the round ligament of uterus are not well described, and opinions and knowledge on the issue vary widely among experienced hernia surgeons.

This is a preview of subscription content, access via your institution.

Fig. 1

References

  1. Kingsnorth A (2004) Treating inguinal hernias. BMJ 328:59–60. https://doi.org/10.1136/bmj.328.7431.59

    Article  PubMed  PubMed Central  Google Scholar 

  2. Weber A, Valencia S, Garteiz D, Burguess A (2001) Epidemology of hernias in the female. In: Bendavid R, Abrahamson J, Arregui ME, Flament JB, Phillips EH (eds) Abdominal wall hernias: principles and management. Springer New York, New York, pp 613–619. https://doi.org/10.1007/978-1-4419-8574-3_90

    Chapter  Google Scholar 

  3. Rosenberg J, Bay-Nielsen M (2008) Current status of laparoscopic inguinal hernia repair in Denmark. Hernia 12:583–587. https://doi.org/10.1007/s10029-008-0399-4

    CAS  Article  PubMed  Google Scholar 

  4. Wake BL, McCormack K, Fraser C, Vale L, Perez J, Grant AM (2005) Transabdominal pre-peritoneal (TAPP) vs totally extraperitoneal (TEP) laparoscopic techniques for inguinal hernia repair. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD004703.pub2

    Article  PubMed  PubMed Central  Google Scholar 

  5. Burcharth J, Andresen K, Pommergaard HC, Bisgaard T, Rosenberg J (2014) Direct inguinal hernias and anterior surgical approach are risk factors for female inguinal hernia recurrences. Langenbecks Arch Surg 399:71–76. https://doi.org/10.1007/s00423-013-1124-z

    Article  PubMed  Google Scholar 

  6. Nilsson H, Holmberg H, Nordin P (2017) Groin hernia repair in women—a nationwide register study. Am J Surg. https://doi.org/10.1016/j.amjsurg.2017.07.027

    Article  PubMed  Google Scholar 

  7. The HerniaSurge Group (2018) International guidelines for groin hernia management. Hernia 22:1–165. https://doi.org/10.1007/s10029-017-1668-x

    Article  Google Scholar 

  8. Cobb WS (2013) Technique: laparoscopic TAPP and IPOM. In: Jacob BP, Ramshaw B (eds) The SAGES manual of hernia repair. Springer New York, New York, pp 81–89. https://doi.org/10.1007/978-1-4614-4824-2_7

    Chapter  Google Scholar 

  9. Yang XF, Liu JL (2016) Laparoscopic repair of inguinal hernia in adults. Ann Transl Med 4:402. https://doi.org/10.21037/atm.2016.10.37

    Article  PubMed  PubMed Central  Google Scholar 

  10. Ando H, Kaneko K, Ito F, Seo T, Ito T (1997) Anatomy of the round ligament in female infants and children with an inguinal hernia. Br J Surg 84:404–405

    CAS  Article  PubMed  Google Scholar 

  11. Drake R, Vogl W, Mitchell AWM (2015) Pelvis and perineum. In: Drake R, Vogl W, Mitchell AWM (eds) Gray’s anatomy for students, 3rd edn. Churchill Livingstone, London, pp 421–532

    Google Scholar 

  12. Mahran M, Ghaleb HA (1964) The physiology of the human round ligament. J Obstet Gynaecol Br Commonw 71:374–378

    CAS  Article  PubMed  Google Scholar 

  13. Yen CF, Wang CJ, Lin SL, Lee CL, Soong YK (2002) Combined laparoscopic uterosacral and round ligament procedures for treatment of symptomatic uterine retroversion and mild uterine decensus. J Am Assoc Gynecol Laparosc 9:359–366. https://doi.org/10.1016/S1074-3804(05)60417-3

    Article  PubMed  Google Scholar 

  14. Lau H, Patil NG, Yuen WK (2005) Is endoscopic totally extraperitoneal hernioplasty justified for the repair of groin hernia in female patients? Surg Endosc 19:1544–1548. https://doi.org/10.1007/s00464-005-0101-1

    CAS  Article  PubMed  Google Scholar 

  15. Lechner M, Fortelny R, Ofner D, Mayer F (2014) Suspected inguinal hernias in pregnancy—handle with care! Hernia 18:375–379. https://doi.org/10.1007/s10029-013-1082-y

    CAS  Article  PubMed  Google Scholar 

  16. Polat AV, Aydin R, Polat AK, Kececi IS, Karahan G, Taskin GO (2013) Round ligament varicosities: a rare cause of groin swelling in pregnancy. Abdom Imaging 38:1178–1181. https://doi.org/10.1007/s00261-013-9984-9

    Article  PubMed  Google Scholar 

  17. von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP (2014) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Int J Surg 12:1495–1499. https://doi.org/10.1016/j.ijsu.2014.07.013

    Article  Google Scholar 

  18. Friis-Andersen H, Bisgaard T (2016) The Danish inguinal hernia database. Clin Epidemiol 8:521–524. https://doi.org/10.2147/clep.s99512

    Article  PubMed  PubMed Central  Google Scholar 

  19. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG (2009) Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42:377–381. https://doi.org/10.1016/j.jbi.2008.08.010

    Article  PubMed  Google Scholar 

  20. The Danish Hernia Database (2016) Annual report from danish hernia database. https://docs.wixstatic.com/ugd/02befe_0a3cf443334f4576b21143d811ccb8fc.pdf. Accessed 31 May 2018

  21. Batioglu S, Zeyneloglu HB (2000) Laparoscopic plication and suspension of the round ligament for chronic pelvic pain and dyspareunia. J Am Assoc Gynecol Laparosc 7:547–551. https://doi.org/10.1016/S1074-3804(05)60373-8

    CAS  Article  PubMed  Google Scholar 

  22. Gargiulo T, Leo L, Gomel V (2000) Laparoscopic uterine suspension using three-stitch technique. J Am Assoc Gynecol Laparosc 7:233–236

    CAS  Article  PubMed  Google Scholar 

  23. Halperin R, Padoa A, Schneider D, Bukovsky I, Pansky M (2003) Long-term follow-up (5–20 years) after uterine ventrosuspension for chronic pelvic pain and deep dyspareunia. Gynecol Obstet Invest 55:216–219. https://doi.org/10.1159/000072077

    Article  PubMed  Google Scholar 

  24. Lin LL, Ho MH, Haessler AL, Betson LH, Alinsod RM, Liu CY, Bhatia NN (2005) A review of laparoscopic uterine suspension procedures for uterine preservation. Curr Opin Obstet Gynecol 17:541–546. https://doi.org/10.1097/01.gco.0000179664.83154.9c

    Article  PubMed  Google Scholar 

  25. Fauconnier A, Dubuisson JB, Foulot H, Deyrolles C, Sarrot F, Laveyssiere MN, Janse-Marec J, Breart G (2006) Mobile uterine retroversion is associated with dyspareunia and dysmenorrhea in an unselected population of women. Eur J Obstet Gynecol Reprod Biol 127:252–256. https://doi.org/10.1016/j.ejogrb.2005.11.026

    Article  PubMed  Google Scholar 

  26. Porpora MG, Gomel V (1997) The role of laparoscopy in the management of pelvic pain in women of reproductive age. Fertility Steril 68:765–779

    CAS  Article  Google Scholar 

  27. Aasvang E, Kehlet H (2005) Chronic postoperative pain: the case of inguinal herniorrhaphy. Br J Anaesth 95:69–76. https://doi.org/10.1093/bja/aei019

    CAS  Article  PubMed  Google Scholar 

  28. Fillingim RB, King CD, Ribeiro-Dasilva MC, Rahim-Williams B, Riley JL (2009) Sex, gender, and pain: a review of recent clinical and experimental findings. J Pain 10:447–485. https://doi.org/10.1016/j.jpain.2008.12.001

    Article  PubMed  PubMed Central  Google Scholar 

  29. Hebert J, Jagtiani M, Hsu A, Schmelzer D, Wolodiger F (2017) Exploring a third confirmed case of hemoperitoneum following open inguinal hernia repair caused by Sampson artery hemorrhage. Case Rep Surg. https://doi.org/10.1155/2017/1487526

    Article  PubMed  PubMed Central  Google Scholar 

  30. Livingston EH, Wislar JS (2012) Minimum response rates for survey research. Arch Surg 147:110. https://doi.org/10.1001/archsurg.2011.2169

    Article  PubMed  Google Scholar 

Download references

Funding

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to L. Schmidt.

Ethics declarations

Conflict of interest

Schmidt and Öberg declare that they have no conflict of interest. Andresen reports personal fees from Bard outside the submitted work. Rosenberg reports personal fees from Bard and Merck outside the submitted work.

Ethical approval

This study was approved by the Danish Data Protection Agency (Journal No. 2712-58-0004). According to Danish Law, no approval from the ethics committee was required for this type of study.

Human and animal rights

Human and/or animal rights were not violated.

Informed consent

Informed consent was given by the participants when replying the questionnaire.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Schmidt, L., Andresen, K., Öberg, S. et al. Dealing with the round ligament of uterus in laparoscopic groin hernia repair: a nationwide survey among experienced surgeons. Hernia 22, 849–855 (2018). https://doi.org/10.1007/s10029-018-1802-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10029-018-1802-4

Keywords

  • Groin hernia
  • Ligamentum rotundum
  • Laparoscopy
  • Female
  • Questionnaire