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Obesity increases the surgical complexity and risk of recurrence after midline primary ventral hernia repair: results on 2307 patients from the French Society of hernia surgery (SFCP-CH) registry database

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Abstract

Purpose

Obesity is a known risk factor of recurrence after hernia surgery, but available data often concern pooled cases of primary and incisional hernia, with short follow-up. We aimed to analyze the impact of severe obesity (BMI ≥ 35 kg/m2) on the results of midline primary ventral hernia repair (mPVHR), in comparison with non-severely obese patients.

Methods

Data were extracted from a multicentric registry, in which patients’ data are consecutively and anonymously collected. We conducted a retrospective comparative study on patients with severe obesity (sOb) versus non-severely obese patients (non-sOb), who underwent surgery, with a minimal 2-year follow-up after their mPVHR.

Results

Among 2307 patients, 267 sOb and 2040 non-sOb matched inclusion criteria. Compared with non-sOb, sOb group gathered all the worse conditions and risk factors: more ASA3-4 (39.3% vs. 10.2%; p < 0.001), symptomatic hernia (15.7% vs. 6.8%; p < 0.001), defect > 4 cm in diameter (24.3% vs. 8.8%; p < 0.001), emergency surgery (6.1% vs. 2.5%; p = 0.003), and Altemeir class > 1 (9.4% vs. 2.9%; p < 0.001). Laparoscopic IPOM was used more often in sOb patients (40% vs. 32%; p = 0.016), but with smaller Hauters’ ratio (46 vs. 73; p < 0.001). Compared with the non-sOb, the rate of day-case surgery was lower (48% vs. 68%; p < 0.001), the surgical site occurrences were significantly more frequent (6.4 %vs. 2.5%; p < 0.001). The main outcome, 2-year recurrence, was 5.9% in the sOb vs. 2.1% (p = 0.008), and 2-year reoperations was 3% vs. 0.3% (p = 0.006). In the adjusted analysis, severe obesity was an independent risk factor for recurrence [OR = 2.82, (95%CI, 1.45; 5.22); p = 0.003].

Conclusion

In patients with severe obesity, mPVHR is technically challenging and recurrence rate is three times higher than that of non-severely obese patients.

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Acknowledgements

We thank members of the Club-Hernie members for input of their data, and therefore the making of this study: Florent Jurczak, Gérard Fromont, André Dabrowski, Marc Soler, Jean-Pierre Cossa, Eric Magne, Constantin Zaranis, Mathieu Beck

Author information

Authors and Affiliations

  1. Department of General Surgery and Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France

    J. Turmine & G. Passot

  2. Hospices Civils de Lyon, University of Lyon I, Lyon, France

    J. Turmine & G. Passot

  3. Department of Epidemiology Biostatistics and Clinical Research, AP-HP Nord, Hôpital Bichat, Paris, France

    A.-M. Florence & C. Tardivon

  4. Université Paris Cité, INSERM, IAME, UMR 1137, Paris, France

    A.-M. Florence

  5. Centre d’Investigations Cliniques-Epidémiologie Clinique 1425, INSERM, Hôpital Bichat, 75018, Paris, France

    C. Tardivon

  6. CICLY EMR 3738 Lyon Sud Charles Mérieux Faculty, Claude Bernard University Lyon 1, Oullins, France

    G. Passot

  7. Unité de Chirurgie Viscérale et Digestive, Ramsay Santé, Hôpital Privé d’Antony, Antony, France

    J.-F. Gillion

  8. Université Paris Cité, Gastrointestinal and Metabolic Dysfunctions in Nutritional Pathologies Centre de Recherche sur l’Inflammation Paris Montmartre INSERM UMRS 1149, 75890, Paris, France

    D. Moszkowicz

  9. Service de Chirurgie Générale et Digestive, AP-HP, Hôpital Louis Mourier, DMU ESPRIT-GHU AP-HP, Nord-Université Paris Cité, 178 rue des Renouillers, 92700, Colombes, France

    D. Moszkowicz

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  1. J. Turmine
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Consortia

SFCP-CH (Club Hernie working group)

  • Florent Jurczak
  • , Gérard Fromont
  • , André Dabrowski
  • , Marc Soler
  • , Jean-Pierre Cossa
  • , Eric Magne
  • , Constantin Zaranis
  •  & Mathieu Beck

Contributions

Study concept and design: DM, J-FG. Acquisition, analysis, or interpretation of data: JT, A-MF, CT, J-FG, GP, DM. Drafting of the manuscript: JT, DM, J-FG. Critical revision of the manuscript for important intellectual content: JT, A-MF, CT, J-FG, GP, DM. Statistical analysis: A-MF, CT. Administrative, technical, or material support: J-FG. Study supervision: GP, J-FG, DM.

Corresponding author

Correspondence to D. Moszkowicz.

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Competing interests

None reported.

Ethical approval

The registry complies with the requirements of the General Data Protection Regulation (GDRP), the French “Méthodologies de reference de la Commission Nationale Informatique et Libertés” (MR001, MR003) and the different specific French ethics committees. STROBE (Strengthening the Reporting of Observational studies in Epidemiology) and the European Registry of Abdominal Wall Hernias (EuraHS) recommendations were used for the conduct and reporting of our study.

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Turmine, J., Florence, AM., Tardivon, C. et al. Obesity increases the surgical complexity and risk of recurrence after midline primary ventral hernia repair: results on 2307 patients from the French Society of hernia surgery (SFCP-CH) registry database. Hernia (2023). https://doi.org/10.1007/s10029-023-02875-z

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