Is it safe to combine ventral hernia repair with bariatric surgery?
Keywords:Morbid obesity, Laparoscopic bariatric surgery, RYGB, LSG, Ventral hernia, Incisional hernia, Recurrence, Panniculectomy
Obesity is one of the important precipitating factors for primary and incisional ventral hernias. There is controversy regarding the optimal time and method of repair of abdominal wall hernias in patients undergoing bariatric surgery. We reviewed our series of 250 patients who underwent bariatric surgery over 6 years period. 7 morbidly obese patients undergoing bariatric surgery had simultaneous ventral hernia repair. Roux-en-Y gastric bypass (RYGB) in 2 patients and laparoscopic sleeve gastrectomy (LSG) were done in 5 patients. 6 patients had primary midline paraumbilical hernia and 1 patient had large recurrent incisional hernia. Open intraperitoneal onlay mesh (IPOM) repair was done in 5 cases with hernia defect <5 cm. Sutured repair was done in 1 patient, recurrence occurred after 3 months. IPOM repair was done 6 months later after significant weight loss. 1 patient of large incisional hernia (10 cm defect) with cholelithiasis underwent open mesh hernioplasty and panniculectomy. Postoperative seroma occurred in one patient, it subsided after repeated aspirations. After average follow up of over 2 years there has been no recurrence.
Lau B, Kim H, Haigh PI and Tejirian T. Obesity increased odds of acquiring and incarcerating non-inguinal abdominal wall hernias. Am Surg. 2012;78(10):1118-21.
Tsereteli Z, Pryor BA, Heniford BT. Laparoscopic ventral hernia repair (LVHR) in morbidly obese patients. Hernia. 2008;12(3):233-8.
Eid, G.M., Wikiel, K.J., Entabi, F. Obes Surg. 2013;23:703.
Park A, Lo Menzo E. The surgeon’s lounge. Gen Surg News. 2010;37(3):26-8.
Newcomb WL, Polhill JL, Chen AY. Staged hernia repair preceded by gastric bypass for the treatment of morbidly obese patients with complex ventral hernias. Hernia. 2008;12(5):465-9.
Eid GM, Mattar SG, Hamad G. Repair of ventral hernias in morbidly obese patients undergoing laparoscopic gastric bypass should not be deferred. Surg Endosc. 2004;18(2):207-10.
Hesselink VJ, Luijendijk RW, de Wilt JH, Heide R, Jeekel J. An evaluation of risk factors in incisional hernia recurrence. Surg Gynecol Obstet. 1993;176(3):228-34.
Datta T, Eid G, Nahmias N, Dallal RM. Management of ventral hernias during laparoscopic gastric bypass. Surg Obes Relat Dis. 2008;4(6):754-7.
Breuing K, Butler CE, Ferzoco S. Incisional ventral hernias: review of the literature and recommendations regarding the grading and technique of repair. Surgery. 2010;148(3):544-58.
Rao RS, Gentileschi P, Kini SU. Management of ventral hernias in bariatric surgery. Surg Obes Relat Dis. 2001;7(1):110-6.
Datta T, George Eid, Nahmias N, Dallal RM. Management of ventral hernias during laparoscopic gastric bypass. Surg Obes Relat Dis. 2008;4(6):754-7.
Krivan S. Concomitant ventral hernia repair and bariatric surgery: A retrospective analysis from a UK based bariatric center. Surg Endosc. 2019;33(3):705-10.
Herbert GS, Tausch TJ, Carter PL. Prophylactic mesh to prevent incisional hernia: a note of caution. Am J Surg. 2009;197(5):595-8.
Jin J, Rosen MJ, Blatnik J. Use of acellular dermal matrix for complicated ventral hernia repair: does technique affect outcomes? J Am Coll Surg. 2007;205(5):654-60.