Case Study: Hernia in a Young Woman-Mesh or No Mesh?


HERNIA IN A YOUNG WOMAN PLANNING A FUTURE PREGNANCY
By Dina Podolsky, MD

Background

A 35 year old woman presents with a symptomatic bulge at her umbilicus.  She’s had the bulge for several years but recently it’s started to cause her intermittent pain and discomfort. At this time, she’s never had any gastrointestinal symptoms like nausea or vomiting. She’s never had surgery and is otherwise healthy. 

She undergoes a CT scan that shows a 2.5 cm umbilical hernia containing a loop of intestine. The patient and her husband are planning on having another child sometime in the next few years. 

Mesh or No Mesh? 

The three options to repair this patient’s hernia are:

  • to do so primarily (with no mesh)
  • to use a piece of synthetic mesh
  • to use a piece of biologic or bioabsorbable mesh that will eventually be broken down by the body. 

The lowest rate of recurrence is with using a piece of synthetic mesh, and the highest is with the primary repair.

Patient Factors to Consider

This patient presents with a symptomatic hernia that contains a loop of intestine, so it should be repaired in order to avoid any future injury to the intestine. The question of whether to use mesh or no mesh in this patient is important because of her age and interest in getting pregnant. Data has shown that using a synthetic mesh in a young woman who may get pregnant can cause pain and discomfort while pregnant; therefore, for an umbilical hernia in a healthy female, a primary closure without mesh can be a good option. This will fix the hernia in the majority of the patients while avoiding any issues with possible future pregnancies.

Takeaways

  • Symptomatic hernias should be repaired
  • Hernias can be repaired with mesh or no mesh; patients should be educated on the potential benefits as well as pitfalls of either option
  • In young women of childbearing age, there can be an added benefit to avoiding mesh placement in the abdomen

Dina Podolsky, MD, is an Assistant Professor of Surgery at Columbia University Medical Center and provider at Columbia’s Hernia Center


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