Abstract
Purpose
The repair of complex abdominal wall hernias in morbidly obese patients is often associated with a higher risk of complications and hernia recurrences. Improvement in obesity and its associated metabolic complications are hypothesized to improve hernia repair outcomes. This study analyzes outcomes from morbidly obese patients who underwent bariatric surgery with staged complex abdominal wall reconstruction at Creighton University Medical Center (CUMC).
Methods
This retrospective study included morbidly obese patients with complex abdominal wall hernia, who underwent bariatric surgery with staged abdominal wall reconstruction. Data points collected included patient demographics, obesity-related co-morbidities, pre-operative BMI, EBMIL at 12 months, hernia characteristics, postoperative complications, BMI at time of hernia repair, and hernia recurrence.
Results
Twelve patients with an average BMI of 48 and complex abdominal wall hernias (mean width 14.0 cm) met inclusion criteria. Seven patients (58%) had significant loss of domain. Bariatric procedures included six laparoscopic sleeve gastrectomies (LSG), three laparoscopic Roux-en-Y gastric bypasses (LRNYGB), and three revisional procedures (2 vertical band gastroplasties to LRNYGB and 1 LRNYGB revision). At 12-month follow-up, the mean excess BMI loss (EBMIL) was 64.6%. The average time to staged complex abdominal wall reconstruction was 22.3 months. Two non-elective hernia repairs were performed due to one incarceration and one strangulation. There were no recurrences after an average follow-up of 21.9 months.
Conclusions
In this study, staged mesh repair of complex abdominal wall hernias after bariatric surgery in morbidly obese patients was associated with acceptable morbidity and no hernia recurrences at approximately 1.5 year follow-up.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Data availability
The authors affirm that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.
References
Slater NJ, Montgomery A, Berrevoet F et al (2014) Criteria for definition of a complex abdominal wall hernia. Hernia 18:7–17. https://doi.org/10.1007/s10029-013-1168-6
Sugerman HJ (2001) Effects of increased intra-abdominal pressure in severe obesity. Surg Clin North Am 81:1063–1075
Tubre DJ, Schroeder AD, Estes J et al (2018) Surgical site infection: the “Achilles Heel” of all types of abdominal wall hernia reconstruction. Hernia 22(6):1003–1013. https://doi.org/10.1007/s10029-018-1826-9
Borbély Y, Zerkowski J, Altmeier J et al (2017) Complex hernias with loss of domain in morbidly obese patients: role of laparoscopic sleeve gastrectomy in a multi-step approach. Surg Obes Relat Dis 13:768–773. https://doi.org/10.1016/j.soard.2017.01.035
Khorgami Z, Haskins IN, Aminian A et al (2017) Concurrent ventral hernia repair in patients undergoing laparoscopic bariatric surgery: a case-matched study using the national surgical quality improvement program database. Surg Obes Relat Dis 13:997–1002. https://doi.org/10.1016/j.soard.2017.01.007
Newcomb WL, Polhill JL, Chen AY et al (2008) Staged hernia repair preceded by gastric bypass for the treatment of morbidly obese patients with complex ventral hernias. Hernia 12:465–469. https://doi.org/10.1007/s10029-008-0381-1
Datta T, Eid G, Nahmias N, Dallal RM (2008) Management of ventral hernias during laparoscopic gastric bypass. Surg Obes Relat Dis 4:754–757. https://doi.org/10.1016/j.soard.2008.03.246
Sauerland S, Korenkov M, Kleinen T et al (2004) Obesity is a risk factor for recurrence after incisional hernia repair. Hernia 8:42–46. https://doi.org/10.1007/s10029-003-0161-x
Spaniolas K, Kasten KR, Mozer AB et al (2015) Synchronous ventral hernia repair in patients undergoing bariatric surgery. Obes Surg 25:1864–1868. https://doi.org/10.1007/s11695-015-1625-7
Cozacov Y, Szomstein S, Safdie FM et al (2014) Is the use of prosthetic mesh recommended in severely obese patients undergoing concomitant abdominal wall hernia repair and sleeve gastrectomy? J Am Coll Surg 218:358–362. https://doi.org/10.1016/j.jamcollsurg.2013.12.008
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of interest
Authors Alexander D Schroeder, Turna Mukherjee, Nara Tashjian, Margaret Siu, Robert Fitzgibbons Jr., and Kalyana Nandipati declare that they have no conflict of interest.
Code availability
Not applicable.
Ethics approval
This research study was conducted retrospectively from data obtained for clinical purposes. We consulted extensively with the IRB of Creighton University, Omaha, Nebraska, who determined that our study did not need ethical approval and was granted exempt status (IRB ID 1034892-6). An IRB official waiver of ethical approval was granted from the IRB of Creighton University.
Informed consent
Patients signed informed consent regarding publishing their data and photographs.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Schroeder, A.D., Mukherjee, T., Tashjian, N. et al. Staged complex abdominal wall hernia repair in morbidly obese patients. Hernia 25, 383–387 (2021). https://doi.org/10.1007/s10029-020-02253-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10029-020-02253-z