Round Ligament Research Articles

8493 Six Clip Hysterectomy

<h3>Study Objective</h3> To demonstrate an efficient, alternative method of performing a total robotic hysterectomy with bilateral salpingo-oophorectomy/salpingectomy using six surgical clips. <h3>Design</h3> Video presentation with narration explaining surgical technique and steps to perform a hysterectomy with six surgical clips. <h3>Setting</h3> Hospital operating room. Patient positioned in dorsal lithotomy in steep Trendelenburg with robot docked in place. Surgeon at console. <h3>Patients or Participants</h3> A 54-year-old woman with pelvic pain and thickened endometrium with history of endometrial ablation years prior for menorrhagia. She presented for total robotic hysterectomy with bilateral salpingo-oophorectomy. <h3>Interventions</h3> The patient was taken to the operating room for a robotic hysterectomy with bilateral salpingo-oophorectomy. The abdomen was entered and the da Vinci Xi robot (da Vinci Intuitive Surgical, Sunnyvale, CA) was docked. The left round ligament was transected, and the retroperitoneal space was entered. Using a large robotic clip applier, a surgical clip was placed on the left uterine artery at its origin. A second clip was placed on the left infundibulopelvic ligament which was then transected. A third clip was placed on the left uterine vessels at the level of the cardinal ligament. The steps were repeated on the opposite side. After the sixth and final clip was placed on the right uterine vessels, the cardinal ligaments were transected bilaterally and the colpotomy was completed. The specimen was removed, while the six surgical clips remained in the body. Minimal bleeding was encountered. Patient recovered well post-operatively with no issues. When performing a hysterectomy with bilateral salpingectomy, the clips are placed on the utero-ovarian ligaments as opposed to the infundibulopelvic ligaments. <h3>Measurements and Main Results</h3> N/A. <h3>Conclusion</h3> We demonstrate an efficient, cost-effective, and alternative method of performing a robotic hysterectomy using six surgical clips. There is less energy use, less thermal damage, and decreased blood loss. This technique is applicable with both bilateral salpingo-oophorectomy and bilateral salpingectomy at the time of hysterectomy.

V-026 UTILITY OF THE LAPAROSCOPIC APPROACH IN INCARCERATED GROIN HERNIAS: A VIDEO-CASE REPORT

Abstract Aims Groin hernias are one of the most frequent pathologies in general surgery.Open repair remains the most widely used method.However,currently the minimally invasive approach is increasing, but the criteria or indications to use this approach in emergency surgery are still not entirely clear. Methods Video-case presentation. Results 62-year-old-man,who came to the emergency-room for abdominal pain, nausea and vomiting, associated with a small painful lump in the right groin.Physical examination:abdominal distension and a painful lump in the lower region of the right inguinal-ligament, non-reducible,CT-scan:small bowel obstruction due to incarcerated femoral-hernia.We decide to perform an urgent surgical-intervention using a minimally-invasive-approach(Lap-TAPP). A laparoscopic-TAPP-approach is performed with 3ports(1×12 and 2×5mm).An incarcerated small bowel is observed in the right-femoral-region with signs of distress and causes retrograde dilation of the small bowel loops,with meticulous pulling maneuvers reduction of the incarcerated small bowel is achieved.Peritoneal opening is performed and the Retzius and Bogros-space is dissected, subsequently the cord is dissected and the round ligament is sectioned,a 10×14cm PPL-mesh is placed.The peritoneum is closed with a 3/0V-Lock.Finally,we reviewed the small bowel and performed an invaginating suture on the incarcerated antimesenteric border.The patient presented a satisfactory evolution and was discharged the 1°POD. Conclusion Incarcerated inguino-crural hernia has a high risk of morbidity and mortality.The surgeon on call must have different technical resources to deal with this pathology.The Lap-TAPP approach allow us to check the viability of the incarcerated small bowel.In selected cases,experienced surgeons can perform laparoscopic small bowel resection and anastomosis in patients with necrosis or perforation.

Rare Vaginal Leiomyoma with Rare Microscopic Findings

Leiomyoma is the most common benign tumor of uterus and rarely may be seen in other parts female reproductive system like the round ligament, utero-sacral ligament, inguinal canal and vagina. Only a few examples of fibroid with vaginal origin have been documented in the literature. With only roughly 300 recorded occurrences, vaginal leiomyomas are still a rare condition. These vaginal fibroids arise most commonly from the anterior vaginal wall causing varied clinical presentations. We report a case of vaginal lateral wall fibroid of 8 cm size and extending into paraurethral space. The vaginal mass was surgically excised and histopathology confirmed the diagnosis of leiomyoma with cartilaginous degeneration.

ROUND LIGAMENT PLICATION FOR IMPROVING EASE OF EMBRYO TRANSFER

The objective of this film is to describe a modified technique of uterine suspension using round ligaments for a novel indication: to improve ease of embryo transfer in a patient with a history of multiple failed embryo transfers and severe uterine retroversion associated with deep infiltrating endometriosis.

The “Trick” Knot—A Modified Technique of the Removable “Shoelace” Knot for Temporary Ligation of the Uterine Artery at Its Origin

To demonstrate the "trick" knot, a technique of temporary ligation of the uterine artery at origin, a modification of the previously published "shoelace" knot. A video demonstration. A private hospital. Bilateral uterine arteries at origin are exposed after dissection of the peritoneum over the triangle formed by the round ligament, the infundibulopelvic ligament, and the pelvic sidewall [Video 1]. A 60-cm long free polyglactin absorbable suture with preformed knots at each end is introduced around the skeletonized uterine artery. Using a single throw, the "trick" knot is made by pulling out a loop of thread. The end is cut short, and the same suture is used to similarly ligate the other uterine artery. Each knot thus formed has a free end and a knotted end. Laparoscopic myomectomy is performed. On completion of the procedure, the knot is released by pulling the free end, restoring the blood supply to the uterus. Bilateral uterine artery ligation, although an effective method to curb bleeding during a laparoscopic myomectomy, when performed permanently, may lead to undesirable outcomes in women who wish to preserve fertility [1-3]. Methods for temporary ligation of the uterine artery at origin, such the removable vascular clips, are thus regarded justifiable [4]. In contrast to the removable "shoelace" knot, which uses a loop to make a throw, the technique of performing the "trick" knot mimics the steps of forming a regular intracorporeal knot [5]. This makes the latter technically easier and hence faster to perform, while still being as economic and reproducible as the former.

Feeding jejunostomy following esophagectomy may increase the occurrence of postoperative small bowel obstruction.

This study aimed to clarify the characteristics and treatment of bowel obstruction associated with feeding jejunostomy in patients who underwent esophagectomy for esophageal cancer. In this single-center retrospective study, 363 patients underwent esophagectomy with mediastinal lymph node dissection for esophageal cancer at the Wakayama Medical University Hospital between January 2014 and June 2021. All patients who underwent esophagectomy routinely underwent feeding jejunostomy or gastrostomy. Feeding jejunostomy was used in the cases of gastric tube reconstruction through the posterior mediastinal route or colon reconstruction, while feeding gastrostomy was used in cases of retrosternal route gastric tube reconstruction. Nasogastric feeding tubes and round ligament technique were not used. Postoperative small bowel obstruction occurred in 19 of 197 cases of posterior mediastinal route reconstruction (9.6%), but in no cases of retrosternal route reconstruction because of the feeding gastrostomy (P < .0001). Of the 19 patients who had bowel obstruction after feeding jejunostomy, 10 patients underwent reoperation (53%) and the remaining 9 patients had conservative treatment (47%). The cumulative incidence of bowel obstruction after feeding jejunostomy was 6.7% at 1 year and 8.7% at 2 years. Feeding jejunostomy following esophagectomy is a risk factor for small bowel obstruction. We recommend feeding gastrostomy inserted from the antrum to the jejunum in the cases of gastric tube reconstruction through the retrosternal route or nasogastric feeding tube in the cases of reconstruction through the posterior mediastinal route.

Uterosacral Ligament Dissection during McCall Culdoplasty to Prevent Ureteral Kinking, and Round Ligament Fixation to Support Vaginal Vault: A New Surgical Technique

Objective: This study aims to describe a new surgical technique to prevent ureteral kinking via dissection uterosacral ligament from parietal peritoneum before McCall culdoplasty suture placement, and vaginal cuff fixation to round ligament to prevent apical vaginal vault prolapse after vaginal hysterectomy. Materials and Methods: At the initial step of vaginal hysterectomy, a circumferential incision was done on vaginal tissue, which covers the uterine cervix. Then posterior cul-de-sac was entered. Bilateral uterosacral ligament was identified, separately clamped, cut and sutured. Classical vaginal hysterectomy was completed up to the round ligament, which was separately grasped, cut and sutured. After the vaginal hysterectomy, the uterosacral ligament dissected from cardinal ligament and parietal peritoneum to prevent ureteral kinking during McCall Culdoplasty suture placement. Two internal McCall sutures with non-absorbable sutures and one external suture with absorbable sutures were place on the uterosacral ligament. Then bilateral apical lateral vaginal walls were fixated to ipsilateral round ligament to further support to vaginal vault. Results: I have applied the new technique to my patients with pelvic organ prolapse for about one year. Ureteral kinking has not occurred in any patient. Early complications such as hemorrhage, bladder and ureter injury did not observed. Conclusion: Ureteral kinking is a challenging problem for gynecologists during suture placement on the uterosacral ligament. Dissection of the uterosacral ligament from the cardinal ligament and parietal peritoneum yielded the surgeon to safe suture passage during McCall Culdoplasty suture placement and eliminated the requirement of cystoscopy evaluation to check ureteral competency.

Laparoscopic Non-Mesh Cerclage Pectopexy for Pelvic Organ Prolapse.

Pelvic organ prolapse (POP) is widespread among the female population and significantly impairs the patient's quality of life. It is important to restore apical support for treating POP. Sacrocolpopexy and pectopexy are indicated for apical prolapse. Using a synthetic mesh in these techniques increases success by enhancing apical support. However, the implantation of synthetic mesh is associated with mesh-related complications. In addition, the exorbitant cost of synthetic mesh and lack of universal access limit the popularity of these procedures. The current study develops a unique technique known as laparoscopic non-mesh cerclage pectopexy (LNMCP), in which permanent cervical cerclage sutures are embedded in the round ligament until the iliopectineal ligament. The iliopectineal ligament was sutured, resulting in a firm cervical suspension. The procedure was successfully performed in 16 cases in the hospital. The surgical duration was 67.8 min ± 15.5 min, and the blood loss was 73.1 mL ± 51.1 mL. No procedural complications were seen. LNMCP is associated with an objective success rate of 100% and a subjective success rate of 93.8%. LNMCP for patients with apical prolapse obviates the need for a mesh, thereby avoiding complications associated with mesh erosion and reducing medical costs. In addition, it is easy to perform even in resource-poor areas without access to synthetic mesh.

Laparoscopic ureteroneocystostomy and round ligament bladder hitching for ureteral stenosis in parametrial deep endometriosis: Our tips for a tension-free anastomosis.

To investigate the feasibility and the efficacy of laparoscopic ureteroneocystostomy with round ligament bladder hitching. This is a monocentric retrospective study. Enrolled patients affected by deep endometriosis underwent laparoscopic nerve-sparing parametrectomy and monolateral ureteroneocystostomy with bladder suspension to the round ligament. Perioperative and postoperative outcomes were collected, as well as urinary and pain symptoms before and after surgery. Laparoscopic ureteroneocystostomy with round ligament bladder hitching was performed in nine women. The most frequent postoperative complication was post-voiding urinary retention (22.2%). No ureteral fistula or stenosis of the anastomosis was reported. In selected cases of ureteral resection and reimplantation, performing a round ligament bladder hitching allowed us to overcome the ureteral gap. This is a safe and feasible procedure to ensure stability of the anastomosis and avoid the possible disadvantages of the "standard" psoas hitch procedure.

Da Vinci robotic assisted pancreaticoduodenectomy with superior mesenteric vein resection and reconstruction

This study demonstrated Da Vinci robot assisted pancreaticoduodenectomy with superior mesenteric vein (SMV) resection and reconstruction. The patient was diagnosed with pancreatic head cancer preoperatively. After anesthesia, trocars were placed by “six-hole method”, and then constant pressure pneumoperitoneum was established. The first step was to remove the gallbladder, open the gastrocolonic ligament, and expose the pancreas and surrounding tissues. After making a Kocher incision, we dissected duodenum, inferior vena cava and uncinate process of pancreas, and then cleaned lymph nodes in groups 13 and 16A. After the stomach was severed using linear stapler, the right gastric artery was dissected and ligated. In this case, the adhesion around the pancreas and common hepatic artery was serious, so the pancreas was transected firstly. The gastroduodenal artery was dissected from the upper edge of the pancreas, and the lymph nodes in groups 7, 8, 9 and 12 were cleaned to expose the common bile duct and portal vein. The common bile duct was transected above the confluence plane of the cystic duct. After opening the colonic mesentery on the left side of the superior mesenteric artery (SMA), the jejunum was severed with a linear cutting obturator. The uncinate process was treated through the middle artery approach; the inferior pancreaticoduodenal artery was severed and lymph nodes were cleaned to the root of SMA and celiac trunk. The tumor and part of the invaded SMV were removed and end-to-end SMV anastomosis was performed. The proper hepatic artery was wrapped with the round hepatic ligament. To protect the stump of gastroduodenal artery, we padded the round hepatic ligament below the pancreaticoduodenal anastomosis. The modified Blumgart method was used for pancreaticointestinal duct to mucosal anastomosis. 4-0 ​V-Lock suture was used for continuous suture of posterior wall and anterior wall respectively, and finally gastrointestinal side-to-side anastomosis was performed. The operation time was 360 ​min and the intraoperative bleeding was 200 ​mL. The patient was discharged 7 days after operation.

Prophylactic surgery plus hyperthermic intraperitoneal chemotherapy (HIPEC CO2) versus standard surgery in colorectal carcinoma at high risk of peritoneal carcinomatosis: short-term and long-term outcomes from the CHECK study – protocol for a randomised, multicentre, phase 3 trial

IntroductionUp to one-fifth of patients with colorectal cancer will develop peritoneal metastases, frequently without other districts’ involvement. Despite the recent unsuccesses of hyperthermic intraperitoneal chemotherapy (HIPEC) for colorectal cancer peritoneal...

A novel technique of sutureless omentopexy during dual-incision laparoscopic peritoneal dialysis catheter insertion to prevent catheter dysfunction due to omental wrapping.

Omental wrapping (OW) is the leading cause of obstruction of the peritoneal dialysis (PD) catheter, which interferes with dialysis treatment. Routinely or selectively performing omentopexy during laparoscopic PD catheter placement has been suggested to prevent OW. However, most of the published techniques for performing this adjunctive procedure require additional incisions and suturing. Herein, we aimed to report our experience in performing omentopexy with a sutureless technique during dual-incision PD catheter insertion. We also performed a comparative analysis to assess the benefit/risk profile of routine omentopexy in these patients. This retrospective study enrolled 469 patients who underwent laparoscopic PD catheter insertion. Their demographic characteristics and operative details were collected from the database of our institution. Omentopexy was performed by fixing the inferior edge of the omentum to the round ligament of the liver using titanium clips. For analysis, the patients were divided into the omentopexy group and the non-omentopexy group. We also reviewed the salvage management and outcomes of patients who experienced OW. The patients were categorized into the omentopexy (n = 81) and non-omentopexy (n = 388) groups. The patients in the non-omentopexy group had a higher incidence of OW, whereas no patient in the omentopexy group experienced this complication (5.2% vs. 0.0%, p = 0.033). The median operative time was 27min longer in patients who underwent omentopexy than in those who did not [100 (82-118) min vs. 73 (63-84) min, p < 0.001]. One patient had an intra-abdominal hematoma after omentopexy and required salvage surgery to restore catheter function. The complication rate of omentopexy was 1.2% (1/81). Sutureless omentopexy during laparoscopic PD catheter insertion is a safe and reliable technique that does not require additional incisions and suturing. Routinely performing omentopexy provides clinical benefits by reducing the risk of catheter dysfunction due to OW.

Arthroscopic-Assisted Toggle Rod Stabilization in Canine Coxofemoral Luxation: A Cadaveric Study.

The aim of this study was to describe an arthroscopic-assisted technique for coxofemoral toggle rod placement, and to report on the feasibility, drill tunnel trajectory and accuracy of tunnel aperture location using this method. Cadaveric pilot study. Eight coxofemoral joints. Craniodorsal coxofemoral joint luxations were artificially created. A simulated open hip reduction and stabilization with a toggle rod were performed through a limited arthrotomy under arthroscopic guidance. Computed tomography scans were performed to evaluate drill hole trajectory across the femoral neck, and joints were disarticulated and photographed. Digital imaging software was used to determine the percent overlap of the drill hole apertures relative to the origin and insertion of the round ligament on the acetabulum and fovea. The exit point of the tunnel was entirely within the fovea capitis in five of eight femurs, three of eight femoral drill apertures were only partially within the target area. Of the eight acetabular bone tunnels examined, all were centred occupying the acetabular fossa. Coxofemoral toggle rod placement can be performed under arthroscopic guidance through a limited arthrotomy. Comparable femoral tunnel accuracy with the standard open technique should be achieved with the current method prior to its clinical use.

Hydrocele of the canal of nuck: A case

The canal of Nuck is a small evagination of the parietal peritoneum, which is attached to the uterus by the round ligament through the internal inguinal ring into the inguinal canal. This structure is homologous to the processus vaginalis of the male anatomy. Hydrocele of the canal of Nuck is a rare disease that occurs in the inguinal area or labium as a painless edema before adolescence. We report the case of a hydrocele of the canal of Nuck in a female adult.

Identifying safe corridors for anterior pelvic percutaneous instrumentation using computed tomography-based anatomical relationships

IntroductionPercutaneous anterior pelvic ring instrumentation is performed for retrograde screw fixation of ramus fractures, as well as for repair of pubic symphysis diastasis. The anatomic relationships of critical structures around the anterior pelvic ring, such as the spermatic cord and round ligament, have been described in only a few studies regarding the risk of iatrogenic injury during surgery. Our goal is to further describe these relationships, as well as provide radiographic information on safe corridors for percutaneous fixation. MethodsEighty (80) axial computed tomography scans of the abdomen, obtained for non traumatic diagnostic purposes and screened for prior abdominal trauma or procedures, were evaluated by 3 fellowship trained radiologists. Mid-symphyseal cuts were used to obtain several measurements relative to the spermatic cords (SC) or round ligaments (RL): inter-cord or inter-ligament distance, skin to cortex of symphysis distance (vertical), skin to cortex of symphysis distance (oblique), safe corridor distance (between SC/RL and femoral triangle), center safe angle (relative to bilateral ischia), maximal safe angle, and minimal safe angle. ResultsThere were 41 male and 39 female scans included in the final analysis. The average inter-cord distance was 50.2 mm, skin to cortex vertical distance of 43.0 mm, skin to cortex oblique distance of 83.5 mm, safe corridor distance 26.3 mm, center safe angle 19.3˚, maximal safe angle 32.3˚, and minimal safe angle 13.6˚. These were further broken down by range and gender in Table 1. Agreement between radiologists was high for these different measurements with the exception of the skin to cortex oblique distance in female patients and the maximal safe angle in female patients, due to absence of round ligament in a majority of the scans. The round ligament was only present at the mid-symphyseal level for our three reviewers in 37/39, 36/39, and 24/39 of female patient scans. ConclusionsWe have identified defined safe corridors for instrumentation of the anterior pelvic ring that can assist the surgeon in percutaneous application of fixation for fracture care.

Comparative analysis of the results of reconstruction of the cardioesophageal transition of the liver round connection and fundoplication by the Nissen–Rosetti method in treatment of hernias

The paper presents a comparative characteristic of the results of surgical treatment of 27 patients with hiatal hernias using the Rampal–Narbona cardiorespexy technique and 16 patients who underwent laparoscopic Nissen– Rosetti fundoplication with cruroraphy. Cardioterespexy according to the Rampal-Narbona technique consists in the use of lig. Teres hepatis with the aim of forming the angle of His, fixing the cardiac part of the stomach and esophagus in the abdominal cavity. There were no cases of mortality. Complications after surgery were observed in older patients who were associated with concomitant pathology. The patients were examined within 10 to 18 months after surgery; in both groups, several cases of relapses and complications were recorded. In percentage terms, these data are as follows: during cardioterespexia surgery, the recurrence rate was 3.7%, signs of esophagitis were observed in 18%, cardia insufficiency was observed in 11.1%, signs of GER were in 11.1%, while in patients, of those operated on according to the Nissen–Rosetti technique, similar indicators were somewhat different: the percentage of relapse was 6.25%, signs of esophagitis were observed in 18.75%, cardiac insufficiency was observed in 18.75%, signs of GER were also in 18.75%. The results obtained indicate a good efficiency of cardiopexy with the round ligament of the liver, and a lower percentage of recurrence and complications in comparison with the Nissen– Rosetti technique (18.7%). The authors see the expediency of using the cardioterespexia technique in clinical practice both in the classical version and subject to its further improvement, which consists in increasing the mechanical properties of the round ligament of the liver and performing this operation by laparoscopic access.

Recurrent postpartum hemorrhage at subsequent pregnancy in patients with prior uterine artery embolization: angiographic findings and outcomes of repeat embolization.

To evaluate angiographic findings and outcomes of uterine artery embolization (UAE) for recurrent postpartum hemorrhage (PPH) in a subsequent pregnancy in patients with a history of prior UAE. Between March 2004 and February 2021, UAE was performed for PPH with gelatin sponge slurry in 753 patients. Among these, 13 underwent repeat UAE for recurrent PPH after subsequent delivery. The causes of PPH, angiographic findings, hemostasis, and adverse events were evaluated. The causes of recurrent PPH included retained placental tissue (n = 9) and uterine atony (n = 4). On angiography, unilateral or bilateral uterine arteries were obliterated due to prior UAE in 10 patients (76.9%). The uterine collateral vessels were embolized (anterior division of the internal iliac artery [n = 10], round ligament [n = 5], and ovarian [n = 4] artery). In the remaining three patients with recanalized or patent (not embolized at prior UAE) uterine arteries, both uterine arteries were embolized. Immediate hemostasis was achieved in nine patients (69.2%). The remaining four patients (30.8%) with obliterated uterine arteries required hysterectomy. There were three mild adverse events (pelvic pain [n = 2] and fever [n = 1]). UAE with gelatin sponge slurry frequently causes permanent uterine artery obliteration. In cases of recurrent PPH occurring in subsequent pregnancy, repeat UAE may be less likely to achieve hemostasis (69.2%). 1. UAE with gelatin sponge slurry frequently caused permanent uterine artery obliteration.2. In recurrent PPH occurring in subsequent pregnancy, the repeat UAE may be less likely to achieve hemostasis than initial UAE.

Preservation of the round ligament to accommodate transient portal hypertension after major hepatectomy

PurposePosthepatectomy liver failure (PHLF) remains a leading cause of death after extensive liver resection. Apart from the size and function of the remaining liver remnant, the development of postresection portal hypertension (pHT) plays a crucial role in the development of PHLF. We hypothesize that the umbilical vein in the preserved round ligament (RL) may recanalize in response to new-onset pHT after extended hepatectomy, thus providing a natural portosystemic shunt.MethodsIn this exploratory study, RL was preserved in 10 consecutive patients undergoing major liver resection. Postoperative imaging was pursued to obtain evidence of reopened umbilical vein in the RL. The postoperative course, including the occurrence of PHLF, as well as the rate of procedure-specific complications were recorded.ResultsNone of the 10 cases presented with an adverse event due to preservation of the RL. In 6 cases, postoperative imaging demonstrated reopening of the umbilical vein with hepatofugal flow in the RL. The rates of procedure-related surgical complications were lower than would be expected in this population; in particular, the rate of occurrence of PHLF as defined by the International Study Group of Liver Surgery (ISGLS) was low.ConclusionOur results support the theoretical concept of portosystemic pressure relief via a preserved umbilical vein after major liver surgery. As preservation of the RL is easily done, we suggest keeping it intact in extended hepatectomy cases and in patients with preexistent pHT.

Accessory and cavitated uterine mass: A rare cause of dysmenorrhea and chronic pelvic pain

Accessory and cavitated uterine mass (ACUM) is a rare developmental uterine anomaly that is said to develop due to duplication of ductal Mullerian tissue. It is an accessory cavity lying along the lateral wall of the uterus near the site of attachment of the round ligament and presents in young females with pelvic pain and dysmenorrhea. Histologically, the cavity is lined with endometrium and smooth muscle bundles similar to the myometrium. Ultrasound is helpful in the identification of the lesion. MRI of the pelvis is the imaging modality of choice for diagnosis. Laparoscopy and histopathology remain confirmatory. This report describes a case of ACUM in a young female who was managed by surgical excision of the mass.

A rare cause similar to inguinal hernia in pregnancy: Two cases of round ligament varicosity

Round ligament varicosities (RLVs) which are a very rare cause of inguinal swelling can mimic an inguinal hernia. RLVs should be considered in the differential diagnosis of inguinal swelling in a female, especially during pregnancy. The diagnosis of RLV can be established on Gray-scale with color Doppler sonography, and, if diagnosed correctly, unnecessary intervention may be prevented. We report two cases of round ligament varicosities in a 30-year-old woman at 30-week gestation and 34-year-old woman at 24-week gestation; these patients were diagnosed using ultrasonography and spontaneously resolved after delivery.