Laparoscopic Ventral Hernia Repair in Bariatric Patients: the Role of Defect Size and Deferred Repair

Abstract

Purpose

To analyze the safety of laparoscopic ventral hernia delayed repair in bariatric patients with a composite mesh.

Materials and Methods

This retrospective single-center observational trial analyzed all bariatric/obese patients with concomitant ventral hernia who underwent laparoscopic abdominal hernia repair before bariatric surgery (group A) and laparoscopic delayed repair after weight loss obtained by the bariatric procedure (group B).

Results

Group A (30 patients) had a mean BMI of 37.8 ± 5.7 kg/m2 (range: 34.0–74.2 kg/m2); group B (170 patients) had a mean BMI of 24.6 ± 4.5 kg/m2 (range 19.0–29.8 kg/m2) (p < 0.05). Mean operative time: group A, 51.7 ± 26.6 min (range 30–120); group B 38.9 ± 21.5 min (range 25–110) (p < 0.05). Average length of stay: group A, 2.0 ± 2.7 days (range 1–5) versus group B, 2.8 ± 1.9 days (range 1–4) (p > 0.5). Recurrent hernia group A 1/30 (3.3%) versus recurrent hernia group B 4/170 (2.3%) (p > 0.5). Bulging: group A, 3/30 (10.0%) versus group B, 0/170 (0%) (p = 0.23).

Conclusion

The present study demonstrates the safety of performing LDR in patient candidates for bariatric surgery in cases of a large abdominal hernia (W2–W3) with a low risk of incarceration or an asymptomatic abdominal hernia. In the case of a small abdominal hernia (W1) or strongly symptomatic abdominal hernia, repair before bariatric surgery, along with subsequent bariatric surgery and any revision of the abdominal wall surgery with weight loss, is preferable.

This is a preview of subscription content, access via your institution.

Fig. 1

References

  1. 1.

    Bosanquet DC, Ansell J, Abdelrahman T, et al. Systematic review and meta-regression of factors affecting midline incisional hernia rates: analysis of 14,618 patients. PLoS One. 2015;10(9) https://doi.org/10.1371/journal.pone.0138745.

  2. 2.

    Olmi S, Magnone S, Erba L, et al. Results of laparoscopic versus open abdominal and incisional hernia repair. JSLS. 2005;9(2):189–95.

    PubMed  PubMed Central  Google Scholar 

  3. 3.

    Itatsu K, Yokoyama Y, Sugawara G, et al. Incidence of and risk factors for incisional hernia after abdominal surgery. Br J Surg. 2014;101:1439–47.

    CAS  Article  Google Scholar 

  4. 4.

    Sanchez VM, Abi-Haidar YE, Itani KM. Mesh infection in ventral incisional hernia repair: incidence, contributing factors, and treatment. Surg Infect. 2011;12:205–10.

    Article  Google Scholar 

  5. 5.

    Olmi S, Scaini A, Cesana GC, et al. Laparoscopic versus open incisional hernia repair: an open randomized controlled study. Surg Endosc. 2007;21(4):555–9.

    CAS  Article  Google Scholar 

  6. 6.

    Muysoms FE, Miserez M, Berrevoet F, et al. Classification of primary and incisional abdominal wall hernias. Hernia. 2009;13(4):407–14. https://doi.org/10.1007/s10029-009-0518-x.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  7. 7.

    Al Chalabi H, Larkin J, Mehigan B, et al. A systematic review of laparoscopic versus open abdominal incisional hernia repair, with meta-analysis of randomized controlled trials. Int J Surg. 2015;20:65–74. https://doi.org/10.1016/j.ijsu.2015.05.050.

    Article  PubMed  Google Scholar 

  8. 8.

    Olmi S, Cesana G, Sagutti L, et al. Laparoscopic incisional hernia repair with fibrin glue in select patients. JSLS. 2010;14(2):240–5. https://doi.org/10.4293/108680810X12785289144359.

    Article  PubMed  Google Scholar 

  9. 9.

    Novitsky YW, Cobb WS, Kercher KW, et al. Laparoscopic ventral hernia repair in obese patients: a new standard of care. Arch Surg. 2006;141(1):57–61.

    Article  Google Scholar 

  10. 10.

    Pierce RA, Spitler JA, Frisella MM, et al. Pooled data analysis of laparoscopic vs. open ventral hernia repair: 14 years of patient data accrual. Surg Endosc. 2007;21(3):378–86.

    Article  Google Scholar 

  11. 11.

    Olmi S, Cesana G, Erba L, et al. Emergency laparoscopic treatment of acute incarcerated incisional hernia. Hernia. 2009;13(6):605–8. https://doi.org/10.1007/s10029-009-0525-y.

    CAS  Article  PubMed  Google Scholar 

  12. 12.

    Tsereteli Z, Pryor BA, Heniford BT, et al. Laparoscopic ventral hernia repair (LVHR) in morbidly obese patients. Hernia. 2008;12(3):233–8.

    CAS  Article  Google Scholar 

  13. 13.

    Paajanen H, Laine H. Operative treatment of massive ventral hernia using polypropylene mesh: a challenge for surgeon and anesthesiologist. Hernia. 2005;9(1):62–7.

    CAS  Article  Google Scholar 

  14. 14.

    Angrisani L, Lorenzo M, Cutolo PP. Incisional hernia in obese patients. In: Incisional hernia. Updates in surgery. Milano: Springer; 2008. ISBN 978-88-470-0721-5.

    Google Scholar 

  15. 15.

    Eid GM, Mattar SG, Hamad G, et al. Repair of ventral hernias in morbidly obese patients undergoing laparoscopic gastric bypass should not be deferred. Surg Endosc. 2004;18(2):207–10.

    CAS  Article  Google Scholar 

  16. 16.

    Newcomb WL, Polhill JL, Chen AY, et al. Staged hernia repair preceded by gastric bypass for the treatment of morbidly obese patients with complex ventral hernias. Hernia. 2008;12(5):465–9. https://doi.org/10.1007/s10029-008-0381-1.

    CAS  Article  PubMed  Google Scholar 

  17. 17.

    Jacob BP, Ramshaw B. The SAGES manual of hernia repair. New York: Springer-Verlag; 2013. ISBN 978-1-4614-4824-2

    Google Scholar 

  18. 18.

    Cozacov Y, Szomstein S, Safdie FM, et al. Is the use of prosthetic mesh recommended in severely obese patients undergoing concomitant abdominal wall hernia repair and sleeve gastrectomy? J Am Coll Surg. 2014;218(3):358–62. https://doi.org/10.1016/j.jamcollsurg.2013.12.008.

    Article  PubMed  Google Scholar 

  19. 19.

    Menzo EL, Hinojosa M, Carbonell A, et al. American Society for Metabolic and Bariatric Surgery and American Hernia Society consensus guideline on bariatric surgery and hernia surgery. Surg Obes Relat Dis. 2018;14(9):1221–32. https://doi.org/10.1016/j.soard.2018.07.005.

    Article  PubMed  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Matteo Uccelli.

Ethics declarations

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of Interest

The authors declare that they have no conflicts of interest.

Ethics Approval and Consent to Participate

IRB approval was not necessary. For this type of study formal consent is not required. Informed consent was obtained from all individual participants included in the study.

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

Verify currency and authenticity via CrossMark

Cite this article

Olmi, S., Uccelli, M., Cesana, G.C. et al. Laparoscopic Ventral Hernia Repair in Bariatric Patients: the Role of Defect Size and Deferred Repair. OBES SURG 30, 3905–3911 (2020). https://doi.org/10.1007/s11695-020-04747-2

Download citation

Keywords

  • Laparoscopic ventral hernia repair
  • Bariatric surgery
  • Sleeve gastrectomy
  • Composite mesh
  • IPOM