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Whether to Sacrifice the Round Ligament? Inguinal Repair
Is the round ligament always or typically cut in an inguinal hernia tissue repair (in females)? In Towfigh’s article “Inguinal Hernia: Four Open Approaches” she states “One can choose to sacrifice the round ligament.” but I have spoken to two surgeons who always transect the round ligament in females. I have also seen Towfigh state that it can be cut with no negative consequences, but I’ve also seen it stated that it supports the uterus during pregnancy.
So how does a surgeon decide whether to sacrifice the round ligament? Is it better to choose a surgeon who only transects the round ligament when necessary rather than routinely cutting it irrespective of individual factors? https://dl.uswr.ac.ir/bitstream/Hannan/91841/1/2018%20SCoNA%20Volume%2098%20Issue%203%20June%20%2814%29.pdf -
6 Replies
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The round ligament originates at the uterine horns (the points at which the fallopian tubes enter the uterus), and attaches to the labia majora, passing through the inguinal canal. The genital branch of genitofemoral nerve also transverses along with it.
It serves a purpose and it’s not irrelevant and justifies being cut because it’s deemed the “weakest” ligament.
If your a female of a child bearing age and enjoy sexual activity do you really want to take a chance of compromising the latter to any degree?
There is also no adequate data that proves cutting the round ligament reduces reoccurrence. It is performed primarily for the convenience of the surgeon to place the mesh more flatly, which can be overcome with alternative techniques; separation from the peritoneum or cutting parallel to the ligament.
Find a surgeon who will go the extra mile for you and respect your body and wishes.
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The round ligament is one of 5 suspensiry ligaments of the uterus, and the weakest of them.
There is no evidence that shows cutting the round ligament in anyway affects the uterus or pregnancy.
I am very interested in this topic as I treat a lot of females. I’ve queried scores of specialists in obstetrics, gynecology, Urogynecology, female urology. All supported round ligament transection with no negative effects.
The purpose of transecting the round ligament is to reduce hernia recurrence, as it results in a flatter hernia closure or patching.
As with any surgery, there are risks. The surgeon must be aware of the anatomy and prevent nerve injury.
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Hi Rose, I would find a surgeon that will go the extra mile and not cut or mess with the round ligament. Cutting the round ligament comes with a high risk of injury to the genital branch of the genitofemoral nerve as it goes along with the round ligament. If it is injured or cut this will lead to labia numbness and atrophy; essentially sexual dysfunction. The round ligament serves an indirect reproductive function for a healthy pregnancy and sexual pleasure. Don’t let a surgeon convince you it doesn’t especially when they’ve never had it cut themselves.
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Why cut a ligament that has a purpose in your body. The round ligament helps maintain the anteversion position of the uterus during pregnancy. By that it help support the uterus by connecting the front of the uterus to the groin region. If this is cut there is going to be compensatory affect to the support of the uterus and cause indirect effect to pregnancy.
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I hear you Osler, but the surgeons cutting the round ligament are also the surgeons who aren’t cutting the cremasteric muscle and are avoiding cutting the nerves — i.e. these are the conservative, minimalist versions of the Shouldice repair and they’re still cutting the round ligament. It is not clear to me whether anyone even offers a Shouldice without transecting the round ligament. Are you finding options, mesh or no-mesh, where the round ligament is preserved?
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