1. 38th International Congress EHS, June 8, 2016
Pregnancy is associated with an increased risk of ventral hernia recurrence: a nationwide register-based study
Erling Oma, Kristian K Jensen, Lars N Jorgensen Digestive Disease Center, Bispebjerg Hospital, Denmark
38th International Congress EHS, June 8, 2016

2. Disclosure of speaker’s interests
(Potential) conflict of interest
None
Potentially relevant company relationships in connection with event1
Sponsorship or research funding2
Fee or other (financial) payment3
Shareholder4
Other relationship, i.e. …5

3. Background
Female ventral hernia repair patients are often of reproductive age No consensus on the timing of surgical repair

4. LaPlace’s law: Intraabdominal volume (V) x Intraabdominal pressure (IAP) Abdominal wall tension (T)

5. Aim
To evaluate if subsequent pregnancy was associated with ventral hernia recurrence

6. Methods
Nationwide cohort study based on Danish Ventral Hernia Database
Umbilical, epigastric or incisional hernia repair January April 2013
Female patients years of age at time of hernia repair
Obstetric history retrieved from Danish Medical Birth Registry until end 2013
Clinical recurrence and/or reoperation from Danish National Patient Registry

7. Baseline Characteristics
Pregnancy (N = 267)
No pregnancy (N = 3311) P
Age, years
30.8 ( )
37.7 ( )
<0.001
Hernia defect, cm2, median (range)
0.8 ( )
0.8 ( )
0.006
Hernia type
Epigastric
76 (28.5)
831 (25.1)
Umbilical
154 (57.7)
1,744 (52.7)
Incisional
37 (13.9)
736 (22.2)
Technique
0.015
Mesh repair
79 (29.6)
1,227 (37.1)
Suture repair
188 (70.4)
2,084 (62.9)
Approach
0.001
Open
236 (88.4)
2,632 (79.5)
Laparoscopic
29 (10.9)
646 (19.5)
Laparoscopic converted to open
2 (0.7)
33 (1.0)
Follow-up, years, median (range)
5.5 ( )
2.9 ( )

8. Extended Cox Regression Analysis of Recurrence
Multivariable model
Characteristics HR
95% CI P
Pregnancy
1.56
0.016
Hernia defect, per 10-unit (cm2) increase
1.02
<0.001
Hernia type
Epigastric
1.00
Umbilical
1.55
0.003
Incisional
3.30
Technique
0.976
Mesh repair
Suture repair
Approach
0.295
Open
Laparoscopic
1.11
0.488
Laparoscopic converted to open
1.66
0.127

9. Discussion Is it safe to postpone repair to after last pregnancy?
Potential pain/discomfort from repair site vs. untreated hernia

10. Limitations Risk of selection bias
No data on body mass index, smoking, surgical site infection
Definition of recurrence

11. Conclusion
Pregnancy following ventral hernia repair was associated with an increased risk of ventral hernia recurrence