Skip to main content

Advertisement

SpringerLink
Log in

Management of ventral hernia in patients with BMI > 30 Kg/m2: outcomes based on an institutional algorithm

  • Original Article
  • Published:
Hernia Aims and scope Submit manuscript

Abstract

Introduction

Management of ventral hernia in obese is a complex problem. The methods of weight loss, alternatives if the patient cannot undergo bariatric surgery, timing, and type of hernia surgery lacks clarity and are dependent on resources and expertise. There is a need for algorithms based on local population and expertise. In this paper, we present the outcomes of our institutional algorithm.

Methods

It was a retrospective analysis of prospectively collected data. Patients with body mass index (BMI) > 30Kg/m2 were included to undergo surgery as per algorithm taking into account (a) presentation (symptomatic vs asymptomatic), (b) hernia characteristics (defect width, site, reducibility), and (c) obesity characteristics (BMI, subcutaneous fat, android vs gynecoid). Data on age, BMI, comorbidities, tobacco consumption, hernia width, location, contents, previous surgery, intraoperative parameters (the type of surgery, mesh, drain, fixation), and outcomes (seroma, hematoma, infection, recurrence) were collected.

Results

A total of 50 patients underwent treatment as per the algorithm. Mean BMI was 36.6 ± 7.3 kg/m2. The mean follow-up was 17.6 ± 7.2 months. The mean defect width was 4.8 ± 2.9 cm. There were two (4%) recurrences in patients who underwent an anatomical repair under emergency conditions. None of the patients who underwent an elective repair had a recurrence. Total surgical site occurrence was 12% and surgical site occurrence requiring procedural intervention was 8%. There was one (2%) mortality on postoperative day 7 due to myocardial infarction.

Conclusion

The algorithm has shown encouraging results in the short-to-medium term. Long-term evaluation with a higher number of patients is needed to confirm its usefulness.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

The primary data are available with the authors and can be sent over email if required.

Abbreviations

IH:

Incisional hernia

BMI:

Body mass index

SSI:

Surgical site infection

BS:

Bariatric surgery

IPOM:

Intraperitoneal onlay meshplasty

RS:

Rives-Stoppa

CS:

Component separation

WHR:

Waist hip ratio

CT:

Computed tomography

LOD:

Loss of domain

VHWG:

Ventral hernia working group

SD:

Standard deviation

DM:

Diabetes mellitus

PCS:

Posterior component separation

ACS:

Anterior component separation

TAR:

Transversus abdominis release

eRS:

Endoscopic Rives-Stoppa

eTAR:

Endoscopic transversus abdominis release

EHS:

European Hernia Society

SSO:

Surgical site occurrence

SSOPI:

Surgical site occurrence requiring procedural intervention

AWR:

Abdominal wall reconstruction

MIS:

Minimally invasive surgery

References

  1. Lau B, Kim H, Haigh PI, Tejirian T (2012) Obesity increases the odds of acquiring and incarcerating noninguinal abdominal wall hernias. Am Surg 78(10):1118–1121

    Article  PubMed  Google Scholar 

  2. Tsereteli Z, Pryor BA, Heniford BT et al (2008) Laparoscopic ventral hernia repair (LVHR) in morbidly obese patients. Hernia 12:233–238. https://doi.org/10.1007/s10029-007-0310-8

    Article  PubMed  CAS  Google Scholar 

  3. Kanters AE, Krpata DM, Blatnik JA et al (2012) Modified hernia grading scale to stratify surgical site occurrence after open ventral hernia repairs. J Am Coll Surg 215:787–793. https://doi.org/10.1016/j.jamcollsurg.2012.08.012

    Article  PubMed  Google Scholar 

  4. Goodenough CJ, Ko TC, Kao LS et al (2015) Development and validation of a risk stratification score for ventral incisional hernia after abdominal surgery: Hernia expectation rates in intra-abdominal surgery (The HERNIA project). J Am Coll Surg 220(4):405–413. https://doi.org/10.1016/j.jamcollsurg.2014.12.027

    Article  PubMed  PubMed Central  Google Scholar 

  5. Yahchouchy-Chouillard E, Aura T, Picone O et al (2003) Incisional hernias: I Related risk factors. Dig Surg 20:3–9

    Article  PubMed  Google Scholar 

  6. Lo ME, Hinojosa M, Carbonell A et al (2018) American Society for Metabolic and Bariatric Surgery and American Hernia Society consensus guideline on bariatric surgery and hernia surgery. Surg Obes Relat Dis 14:1221–1232. https://doi.org/10.1016/j.soard.2018.07.005

    Article  Google Scholar 

  7. Henriksen NA, Bisgaard T, Helgstrand F (2020) Smoking and obesity are associated with increased readmission after elective repair of small primary ventral hernias: A nationwide database study. Surg (United States). https://doi.org/10.1016/j.surg.2020.04.012

    Article  Google Scholar 

  8. Park H, de Virgilio C, Kim DY et al (2020) Effects of smoking and different BMI cutoff points on surgical site infection after elective open ventral hernia repair. Hernia. https://doi.org/10.1007/s10029-020-02190-x

    Article  PubMed  Google Scholar 

  9. Eid GM, Wikiel KJ, Entabi F, Saleem M (2013) Ventral hernias in morbidly obese patients: a suggested algorithm for operative repair. Obes Surg 23:703–709. https://doi.org/10.1007/s11695-013-0883-5

    Article  PubMed  Google Scholar 

  10. Levi B, Zhang P, Lisiecki J et al (2014) Use of morphometric assessment of body composition to quantify risk of surgical-site infection in patients undergoing component separation ventral hernia repair. 2014 Apr;133(4):559e-66e. https://doi.org/10.1097/PRS.0000000000000009. PMID: 24675208.

    Article  PubMed  Google Scholar 

  11. Krivan MS, Giorga A, Barreca M et al (2019) Concomitant ventral hernia repair and bariatric surgery: a retrospective analysis from a UK-based bariatric center. Surg Endosc 33:705–710

    Article  PubMed  Google Scholar 

  12. Zavlin D, Jubbal KT, Van Eps JL et al (2018) Safety of open ventral hernia repair in high-risk patients with metabolic syndrome: a multi-institutional analysis of 39,118 cases. Surg Obes Relat Dis 14:206–213. https://doi.org/10.1016/j.soard.2017.09.521

    Article  PubMed  Google Scholar 

  13. Nishida C (2004) Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 363:157–163

    Article  Google Scholar 

  14. Misra A, Chowbey P, Makkar BM et al (2009) Consensus statement for diagnosis of obesity, abdominal obesity and the metabolic syndrome for asian indians and recommendations for physical activity, medical and surgical management. J Assoc Physicians India 57:163–170

    PubMed  CAS  Google Scholar 

  15. Novitsky YW, Elliott HL, Orenstein SB, Rosen MJ (2012) Transversus abdominis muscle release: a novel approach to posterior component separation during complex abdominal wall reconstruction. Am J Surg 204:709–716. https://doi.org/10.1016/j.amjsurg.2012.02.008

    Article  PubMed  Google Scholar 

  16. Belyansky I, Daes J, Radu VG et al (2017) A novel approach using the enhanced-view totally extraperitoneal (eTEP) technique for laparoscopic retromuscular hernia repair. Surg Endosc. https://doi.org/10.1007/s00464-017-5840-2

    Article  PubMed  Google Scholar 

  17. Baig S, Priya P (2018) Extended totally extraperitoneal repair (eTEP) for ventral hernias: Short-term results from a single centre. J Minim Access Surg. https://doi.org/10.4103/jmas.JMAS_29_18

    Article  Google Scholar 

  18. Berriós-Torres SI, Umscheid CA, Bratzler DW et al (2017) Centers for disease control and prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg 152:784–791

    Article  PubMed  Google Scholar 

  19. Bittner R, Bain K, Bansal VK et al (2019) Update of Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (International Endohernia Society (IEHS))—Part A. Surg Endosc 33:3069–3139. https://doi.org/10.1007/s00464-019-06907-7

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  20. Heniford BT, Park A, Ramshaw BJ et al (2003) Laparoscopic repair of ventral hernias: nine years’ experience with 850 consecutive hernias. Ann Surg 238(3):391–399. https://doi.org/10.1097/01.sla.0000086662.49499.ab

    Article  PubMed  PubMed Central  Google Scholar 

  21. Sartelli M, Coccolini F, van Ramshorst GH et al (2013) WSES guidelines for emergency repair of complicated abdominal wall hernias. World J Emerg Surg 8:50. https://doi.org/10.1186/1749-7922-8-50

    Article  PubMed  PubMed Central  Google Scholar 

  22. Baig SJ, Priya P (2018) Tailored approach to ventral hernia—our proposed algorithm. Indian J Surg 80:205–206

    Article  PubMed  PubMed Central  Google Scholar 

  23. Novitsky YW, Cobb WS, Kercher KW et al (2006) Laparoscopic ventral hernia repair in obese patients: A new standard of care. Arch Surg 141:57–61. https://doi.org/10.1001/archsurg.141.1.57

    Article  PubMed  Google Scholar 

  24. Giordano SA, Garvey PB, Baumann DP et al (2017) The impact of body mass index on abdominal wall reconstruction outcomes: A comparative study. Plast Reconstr Surg 139:1234–1244. https://doi.org/10.1097/PRS.0000000000003264

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  25. Warren JA, Epps M, Debrux C et al (2015) Surgical site occurrences of simultaneous panniculectomy and incisional hernia repair. Am Surg 81:764–769

    Article  PubMed  Google Scholar 

  26. Espinosa-de-los-Monteros A, Avendaño-Peza H, Gómez-Arcive Z et al (2016) Total abdominal wall reconstruction with component separation, reinforcement, and vertical abdominoplasty in patients with complex ventral hernias. Aesthetic Plast Surg 40:387–394. https://doi.org/10.1007/s00266-016-0628-7

    Article  PubMed  Google Scholar 

  27. Giordano S, Garvey PB, Baumann DP et al (2017) Concomitant panniculectomy affects wound morbidity but not hernia recurrence rates in abdominal wall reconstruction: a propensity score analysis. Plast Reconstr Surg 140:1263–1273. https://doi.org/10.1097/PRS.0000000000003855

    Article  PubMed  CAS  Google Scholar 

  28. Eid GM, Mattar SG, Hamad G et al (2004) Repair of ventral hernias in morbidly obese patients undergoing laparoscopic gastric bypass should not be deferred. Surg Endosc Other Interv Tech 18:207–210

    Article  CAS  Google Scholar 

  29. 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

    Article  PubMed  Google Scholar 

  30. Bonatti H, Hoeller E, Kirchmayr W et al (2004) Ventral hernia repair in bariatric surgery. Obes Surg 14:655–658. https://doi.org/10.1381/096089204323093444

    Article  PubMed  Google Scholar 

  31. Schuster R, Curet MJ, Alami RS et al (2006) Concurrent gastric bypass and repair of anterior abdominal wall hernias. Obes Surg 16:1205–1208. https://doi.org/10.1381/096089206778392374

    Article  PubMed  Google Scholar 

  32. 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

    Article  CAS  PubMed  Google Scholar 

  33. Praveen Raj P, Bhattacharya S, Saravana Kumar S et al (2019) Morbid obesity with ventral hernia: is concomitant bariatric surgery with laparoscopic ventral hernia mesh repair the best approach? An experience of over 150 cases. Surg Obes Relat Dis 15:1098–1103. https://doi.org/10.1016/j.soard.2019.04.027

    Article  PubMed  Google Scholar 

  34. Chan DL, Talbot ML, Chen Z, Kwon SCM (2014) Simultaneous ventral hernia repair in bariatric surgery. ANZ J Surg 84:581–583. https://doi.org/10.1111/ans.12174

    Article  PubMed  Google Scholar 

  35. Raziel A, Sakran N, Szold A, Goitein D (2014) Concomitant bariatric and ventral/incisional hernia surgery in morbidly obese patients. Surg Endosc 28:1209–1212. https://doi.org/10.1007/s00464-013-3310-z

    Article  PubMed  Google Scholar 

  36. Sharma G, Boules M, Punchai S et al (2017) Outcomes of concomitant ventral hernia repair performed during bariatric surgery. Surg Endosc 31:1573–1582. https://doi.org/10.1007/s00464-016-5143-z

    Article  PubMed  CAS  Google Scholar 

  37. Lazzati A, Nassif GB, Paolino L (2018) Concomitant ventral hernia repair and bariatric surgery: a systematic review. Obes Surg 28:2949–2955

    Article  PubMed  Google Scholar 

  38. Birgisson G, Park AE, Mastrangelo MJ et al (2001) Obesity and laparoscopic repair of ventral hernias. Surg Endosc 15:1419–1422. https://doi.org/10.1007/s004640080077

    Article  PubMed  CAS  Google Scholar 

  39. Sugerman HJ, Kellum JM, Reines HD et al (1996) Greater risk of incisional hernia with morbidly obese than steroid-dependent patients and low recurrence with prefascial polypropylene mesh. Am J Surg 171:80–84. https://doi.org/10.1016/S0002-9610(99)80078-6

    Article  PubMed  CAS  Google Scholar 

  40. Bower CE, Reade CC, Kirby LW, Roth JS (2004) Complications of laparoscopic incisional-ventral hernia repair: The experience of a single institution. Surg Endosc Other Interv Tech 18:672–675

    CAS  Google Scholar 

  41. Raftopoulos I, Courcoulas AP (2007) Outcome of laparoscopic ventral hernia repair in morbidly obese patients with a body mass index exceeding 35 kg/m2. Surg Endosc Other Interv Tech 21:2293–2297. https://doi.org/10.1007/s00464-007-9406-6

    Article  CAS  Google Scholar 

  42. Olmi S, Uccelli M, Cesana GC et al (2020) Laparoscopic ventral hernia repair in bariatric patients: the role of defect size and deferred repair. Obes Surg. https://doi.org/10.1007/s11695-020-04747-2

    Article  PubMed  PubMed Central  Google Scholar 

  43. Schlosser KA, Arnold MR, Otero J et al (2019) Deciding on optimal approach for ventral hernia repair: laparoscopic or open. J Am Coll Surg 228:54–65. https://doi.org/10.1016/j.jamcollsurg.2018.09.004

    Article  PubMed  Google Scholar 

  44. Vilallonga R, Fort JM, Gonzalez O et al (2011) Management of patients with hernia or incisional hernia undergoing surgery for morbid obesity. J Obes. https://doi.org/10.1155/2011/860942

    Article  PubMed  Google Scholar 

Download references

Funding

Not applicable

Author information

Authors and Affiliations

  1. Belle Vue Clinic, 9 and 10, Loudon street, Kolkata, India

    S. J. Baig & P. Priya

Authors
  1. S. J. Baig
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. Priya
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Sarfaraz Baig: conceptualization, methodology, data collection, writing-original draft preparation, draft modifications. Pallawi Priya: methodology, data collection, writing-original draft preparation, draft modifications. Both authors have seen and approved the final version.

Corresponding author

Correspondence to P. Priya.

Ethics declarations

Conflict of interest

Pallawi Priya and Sarfaraz Baig have no conflict of interests to declare.

Ethical approval

Ethical approval was waived for this article owing to the retrospective analysis of data and no disclosure of patients' identities.

Human and animal rights

The Study was performed in concordance with all human and animal rights standards.

Informed consent

All patients gave written informed consent before the surgery which included the consent to collect and publish the anonymized data.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Baig, S.J., Priya, P. Management of ventral hernia in patients with BMI > 30 Kg/m2: outcomes based on an institutional algorithm . Hernia 25, 689–699 (2021). https://doi.org/10.1007/s10029-020-02318-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10029-020-02318-z

Keywords

Search

Navigation