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Objective follow-up after transection of uterine round ligament during laparoscopic repair of inguinal hernias in women: assessment of safety and long-term outcomes

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Abstract

Background

Whether to preserve the uterine round ligament during laparoscopic inguinal hernia repair in women is controversial. In this study, we aimed to compare outcomes of uterine round ligament preservation versus transection during such surgery and to explore the impact and long-term outcomes of transecting the round ligament.

Methods

The study cohort comprised 419 women who had undergone laparoscopic inguinal hernia repair in Beijing Chaoyang Hospital and Qilu Hospital from January 2013 to January 2020; 393 (93.8%) of whom were successfully followed up. Patient characteristics and technical details of the operative procedure were collected and analyzed retrospectively. Early and late postoperative follow-up data, complications, especially symptoms related to retroflexed uterus, and fertility outcomes, were collected by a single follow-up nurse who was blinded to the operative procedure.

Results

There were 218 women (239 sides) in the uterine round ligament preservation group and 175 (182 sides) in the transection group. The patients in the preservation group were younger (45.9 vs. 53.6 years, p = 0.000), and had lower American Society of Anesthesiologists scores (p = 0.000). The median follow-up times in the preservation and transection groups were 41.8 ± 24.2 and 42.7 ± 24.6 months, respectively (p = 0.692). Compared with the transection group, the preservation group had longer operative times for repair of both primary and recurrent hernias. Intraoperative bleeding, length of hospital stay, development of seromas, recurrence rate, incidence of postoperative pain at the first and third postoperative months, and time of last outpatient visit were similar in the two groups. There were more premenopausal patients in the preservation group; however, we found no evidence that transection of the round ligament affected subsequent pregnancy or childbirth. Moreover, we identified no differences in dyspareunia, dysmenorrhea, chronic pelvic pain, or uterine prolapse.

Conclusion

Transection of the round ligament during laparoscopic inguinal hernia repair in women does not increase the incidence of dyspareunia, dysmenorrhea, chronic pelvic pain, or uterine prolapse, whereas it has the advantage of reducing the operation time.

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Acknowledgements

We thank Dr Trish Reynolds, MBBS, FRACP, from Liwen Bianji, Edanz Group China (www.liwenbianji.cn/ac), for editing the English text of a draft of this manuscript.

Funding

This study was supported by fellowships from the China Postdoctoral Science Foundation (Grant No. 2020M682191) and Key Research and Development Project of Shandong Province (Grant No. 2019GSF108151).

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Author notes

  1. Yuchen Liu and Junying Liu have contributed equally to the manuscript.

Authors and Affiliations

  1. Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100043, China

    Yuchen Liu & Minggang Wang

  2. Operating Theater, Qilu Hospital, Cheeloo of Medicine, Shandong University, Jinan, No. 107, Wenhua West Road, Jinan, 250012, Shandong Province, China

    Junying Liu

  3. Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University, No. 16766, Jingshi Road, Jinan, 250014, Shandong Province, China

    Qian Xu & Guangyong Zhang

  4. Department of Colorectal Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, No. 107, Wenhua West Road, Jinan, 250012, Shandong Province, China

    Binbin Zhang & Zhibo Yan

  5. Nursing Theory and Practice Innovation Research Center of Shandong University, No. 44, Wenhua West Road, Jinan, 250012, Shandong Province, China

    Binbin Zhang

  6. Key Laboratory Experimental Teratology of the Ministry of Education and Department of Physiology, School of Basic Medical Sciences, Cheeloo College of Medicine, Shandong University, No. 107, Wenhua West Road, Jinan, 250012, Shandong Province, China

    Zhibo Yan

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  1. Yuchen Liu
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Correspondence to Guangyong Zhang or Zhibo Yan.

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Authors Yuchen Liu, Junying Liu, Qian Xu, Binbin Zhang, Minggang Wang, Guanyong Zhang and Zhibo Yan have no conflicts of interest or financial ties to disclose.

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Liu, Y., Liu, J., Xu, Q. et al. Objective follow-up after transection of uterine round ligament during laparoscopic repair of inguinal hernias in women: assessment of safety and long-term outcomes. Surg Endosc 36, 3798–3804 (2022). https://doi.org/10.1007/s00464-021-08696-4

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  • DOI: https://doi.org/10.1007/s00464-021-08696-4

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