Recurrent umbilical or epigastric hernia during and after pregnancy: A nationwide cohort study

Abstract

Umbilical and epigastric (umb/epi) hernia repairs are performed commonly in fertile female patients. Recent studies suggest mesh repair to be superior to suture repair; however, evidence is lacking concerning the optimal treatment of umb/epi hernias in female patients who might wish future pregnancies. The aim of this study was to compare the cumulative recurrence rate after mesh versus suture repair of umb/epi hernia in female patients subsequently becoming pregnant. This retrospective nationwide cohort study included female patients who underwent primary umb/epi hernia repair and subsequently became pregnant between 2007 and 2013. The follow-up began at first day of pregnancy and ended May 2015. Data were obtained from the Danish Ventral Hernia Database, Medical Birth Registry, and National Patient Registry. Patients with recurrence before pregnancy were excluded. In total, 224 patients were analyzed. The median follow-up was 3.8years (range 0.1-8.1). The cumulative recurrence rate was 16.3% after mesh repair and 10.9% after suture repair, P=.299. Univariate Cox regression analysis (mesh repair hazard ratio 1.63, 95% confidence interval 0.71-3.72, P=.249) and multivariate analysis adjusted for body mass index and hernia defect size (mesh repair hazard ratio 2.77, confidence interval 0.98-7.85, P=.055) likewise showed no significant difference in the risk of recurrence when we compared mesh and suture repair. Contrary to findings in the general operative patient, mesh repair was not associated with a lesser risk of recurrence compared with suture repair for treatment of umb/epi hernia in female patients with subsequent pregnancy.