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Ventral Hernia Repair and Obesity: Results from a Nationwide Register Study in France According to the Timeframes of Hernia Repair and Bariatric Surgery

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Abstract

Purpose

Several strategies are suggested for ventral hernia repair (VHR) in bariatric candidates, in terms of timing and technique. The aim was to describe practices in VHR in bariatric patients on a nationwide scale in France.

Materials and Methods

We used the prospective national hospital discharge summaries database system to conduct a retrospective cohort study. We included patients operated once for sleeve or bypass, between 2007 and 2018, and who had VHR concomitant with bariatric surgery (BS) or within 2 years before or after.

Results

Among 11,680 eligible patients, 2039 underwent VHR in the 2 years before BS, 3388 had concomitant BS and VHR, and 6260 patients had VHR within 2 years after BS. Patients who underwent a concomitant surgery presented a higher suture repair rate (86.1% versus 37.1% and 44.0%, P < 0.001). Overall recurrence of VH at 10 years was 23.3% and was higher for patients who underwent VHR first (36.2%) than patients who underwent BS first (24.5%) and the concomitant group (18.6%), P < 0.001. Major complication rate was 11.1%, 7.8%, and 16.9% (P < 0.001) for VHR-first, concomitant, and BS-first groups, respectively. Mesh infection was found in 0.6% (13/2039) of patients in the VHR-first group, in 0.6% (20/3388) in the concomitant group, and in 1.1% (68/6260) in the BS-first group (P < 0.001).

Conclusion

About one-quarter of bariatric patients undergoing VHR will be reoperated for an anterior hernia. VHR before BS entailed a higher risk of reoperation for recurrence and should be avoided. A concomitant repair entailed the lowest rate of recurrence.

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Authors and Affiliations

  1. Université de Paris, Gastrointestinal and Metabolic Dysfunctions in Nutritional Pathologies Centre de Recherche Sur L’Inflammation Paris Montmartre INSERM UMRS 1149, 75890, Paris, France

    David Moszkowicz

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

    David Moszkowicz & Davide Giovinazzo

  3. Clinical Research Unit, AP-HP Paris Saclay Ouest, 92100, Boulogne-Billancourt, France

    Madalina Jacota, Lionelle Nkam & Lamiae Grimaldi

  4. Department of General Surgery, Centre Hospitalier Intercommunal de Créteil, 94000 Créteil; INSERM UMRS 1138, Centre de Recherche Des Cordeliers, Université Paris Descartes, Paris, France

    Andrea Lazzati

Authors
  1. David Moszkowicz
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  2. Madalina Jacota
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  3. Lionelle Nkam
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  4. Davide Giovinazzo
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  5. Lamiae Grimaldi
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  6. Andrea Lazzati
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Corresponding author

Correspondence to David Moszkowicz.

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Ethics Approval

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.

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The individual information is anonymous and publicly available, and thus, patient consent is not required (register study).

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Key Points

• The overall ventral hernia repair (VHR) rate at 10 years was 23.3%.

• VH repair before obesity surgery was associated with an increased risk of reoperation.

• Patients with either concomitant or postbariatric VHR had a higher risk of surgical site infection.

• The lowest recurrence rate was observed in the concomitant VH repair and BS group (18.6%).

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Moszkowicz, D., Jacota, M., Nkam, L. et al. Ventral Hernia Repair and Obesity: Results from a Nationwide Register Study in France According to the Timeframes of Hernia Repair and Bariatric Surgery. OBES SURG 31, 5251–5259 (2021). https://doi.org/10.1007/s11695-021-05720-3

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  • DOI: https://doi.org/10.1007/s11695-021-05720-3

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