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Management of abdominal wall hernias in patients with severe obesity

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Abstract

Obesity is a risk factor for abdominal wall hernia development and hernia recurrence. The management of these two pathologies is complex and often entwined. Bariatric and ventral hernia surgery require careful consideration of physiologic and technical components for optimal outcomes. In this review, a multidisciplinary group of Society of American Gastrointestinal and Endoscopic Surgeons’ bariatric and hernia surgeons present the various weight loss modalities available for the pre-operative optimization of patients with severe obesity and concurrent hernias. The group also details the technical aspects of managing abdominal wall defects during weight loss procedures and suggests the optimal timing of definitive hernia repair after bariatric surgery. Since level one evidence is not available on some of the topics covered by this review, expert opinion was implemented in some instances. Additional high-quality research in this area will allow for better recommendations and therefore treatment strategies for these complex patients.

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Acknowledgements

The authors would like to thank the SAGES executive team members for their assistance and support.

Funding

None to declare.

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Authors and Affiliations

  1. Department of Surgery, Mayo Clinic, Rochester, MN, 55905, USA

    Omar M. Ghanem

  2. Division of Gastrointestinal and General Surgery, Oregon Health and Science University, Portland, OR, USA

    Sean Orenstein

  3. Department of Surgery, Baylor College of Medicine, Houston, TX, USA

    S. Julie-Ann Lloyd

  4. Department of Surgery, McGill University, Montreal, QC, USA

    Amin Andalib

  5. Department of Surgery, West Virginia University, Morgantown, WV, USA

    Alice Race

  6. Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), Los Angeles, CA, USA

    Holly Ann Burt

  7. College of Medicine, University of Arizona, Phoenix, AZ, USA

    Farah Husain

  8. Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA

    Matthew Goldblatt

  9. Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA

    Matthew Kroh

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  1. Omar M. Ghanem
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  2. Sean Orenstein
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  4. Amin Andalib
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  5. Alice Race
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  7. Farah Husain
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  8. Matthew Goldblatt
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  9. Matthew Kroh
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Consortia

SAGES Metabolic, Bariatric Surgery Committee, SAGES Hernia Committee

Corresponding author

Correspondence to Omar M. Ghanem.

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Disclosures

Omar M. Ghanem, Sean Orenstein, S. Julie-Ann Lloyd, Amin Andalib, Alice Race, Holly Ann Burt, Farah Husain, Matthew Goldblatt, and Matthew Kroh report no disclosures or conflicts of interests.

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Ghanem, O.M., Orenstein, S., Lloyd, S.JA. et al. Management of abdominal wall hernias in patients with severe obesity. Surg Endosc 37, 6619–6626 (2023). https://doi.org/10.1007/s00464-023-10312-6

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  • DOI: https://doi.org/10.1007/s00464-023-10312-6

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