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Review
. 2021 Apr-Jun;25(2):e2020.00112.
doi: 10.4293/JSLS.2020.00112.

Herniation Through Defects in the Broad Ligament

Abin Sajan  1 , Hazim Hakmi  1 , Daniel W Griepp  2 , Amir H Sohail  1 , Helen Liu  1 , David Halpern  1
Affiliations
Review

Herniation Through Defects in the Broad Ligament

Abin Sajan et al. JSLS. 2021 Apr-Jun.

Abstract

Background: We sought to assess hernia characteristics and classification through comprehensive review of the literature involving broad ligament herniation.

Methods: A literature search via MEDLINE and Embase databases was conducted to identify and select broad ligament herniation studies published between January 1, 2000 and September 30, 2020. Extracted data included previous surgical history, previous obstetric history, diagnostic imaging, herniated organ, hernia classification, and repair performed. The reported data has been compared to a unique case of broad ligament herniation that presented to our institution.

Results: A total of 44 articles with 49 cases were identified for the study. Eighteen (36.7%) patients had a history of previous abdominal surgery while 29 (59.2%) had a history of previous childbirth. Type I (51.0%) and Type II (18.4%) defects were most commonly reported with most patients reporting only one defect (85.7%) using the Cilley classification. Twenty-nine patients underwent primary laparoscopic repair of the defect while 19 patients underwent exploratory laparotomy.

Conclusions: The analysis of previously reported cases adds to the limited literature on broad ligament hernias and highlights the surgical management of this uncommon pathology. It also highlights the need for a broad differential diagnosis when female patients present with pelvic pain or symptoms of small bowel obstruction. The broad ligament should be fully inspected when mesenteric defects are suspected as multiple defects can be present as evidenced by the attached case study.

Keywords: Broad ligament; Hernia; Minimally invasive surgery; Small bowel.

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Conflict of interest statement

Conflict of interests: none.

Figures

Figure 1.
Figure 1.
Transition point visualized at the White arrow (A) with the uterus and the left ovary visualized anteriorly and inferiorly (B).
Figure 2.
Figure 2.
(A) Type I defect (White arrow) and type II defect (Black arrow); (B) pelvic sciatic hernial defect (Black arrow), along with the pelvic congestion syndrome, demonstrated by the chronically engorged pelvic venous structures (ovarian vessels and presacral venous complex); (C) Repaired type I and II defects (White and Black arrows); and (D) repaired pelvic sciatic hernia (Black arrow).
Figure 3.
Figure 3.
Variations of defects through the broad ligament. UT, Uterus; O, Ovary; RL, Round Ligament.
See this image and copyright information in PMC

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