Top

Published in:

01-04-2017

Outcomes of concomitant ventral hernia repair performed during bariatric surgery

Authors: G. Sharma, M. Boules, S. Punchai, A. Strong, D. Froylich, N. H. Zubaidah, C. O’Rourke, S. A. Brethauer, J. Rodriguez, K. El-Hayek, M. Kroh

Published in: Surgical Endoscopy | Issue 4/2017

Abstract

Background

Currently there is no consensus on management of ventral hernias encountered during bariatric surgery (BS). This study aims to evaluate the incidence and outcomes of concomitant ventral hernia repair (VHR) during BS at our institution.

Methods

Patients who had concomitant VHR during BS from 2004 to 2015 were identified. Data collected included baseline demographics, comorbidities, perioperative parameters, surgical approach and postoperative outcomes.

Results

A total of 159 patients underwent concomitant VHR during the study period at the time of BS. One hundred and one (64 %) patients were female; median age was 53 years (IQR 45.0–60.3) and median BMI was 48.2 kg/m² (IQR 41.6–54.1). Comorbidities included: hypertension (n = 124, 78 %), type 2 diabetes (n = 103, 65 %), hyperlipidemia (n = 100, 63 %), obstructive sleep apnea (n = 98, 62 %) and reflux disease (n = 54, 34 %). Out of 159 patients, 41 patients (26 %) had a prior VHR. Out of 103 patients, 69 patients (67 %) had a previous abdominal surgery. Of the concomitant VHR, 144 (91 %) were completed laparoscopically, 12 (7 %) patients were converted to open surgery and 3 (2 %) patients underwent primary open procedures. Technique included primary suture closure in 115 (72 %) and mesh repair in 44. Early postoperative complications (<30 days) were reported in 16 (10 %) patients, with superficial wound infection (n = 9), bowel obstruction (n = 2), marginal ulcer (n = 2), DVT (n = 1) and pneumonia (n = 1). Hernia recurrence was reported in 3 patients (2 %) in the early post-op period and in 40 patients (25 %) as a late (>30 days) complication. Surgery for recurrent hernia was performed in 31/42 patients during follow-up. At 12-month follow-up, median BMI and % excess weight loss were 34.2 kg/m² (IQR 29.5–40.9) and 59.6 % (IQR 44.9–74.8 %), respectively.

Conclusion

Ventral hernia is a common finding in patients undergoing BS. Both primary suture repair and mesh repair result in acceptable results, both in terms of recurrence and perioperative complications.

Datta T, Eid G, Nahmias N, Dallal RM (2008) Management of ventral hernias during laparoscopic gastric bypass. Surg Obes Relat Dis 4:754–757. doi:10.1016/j.soard.2008.03.246 CrossRefPubMed

Sugerman HJ, Kellum JM, Reines HD, DeMaria EJ, Newsome HH, Lowry JW (1996) Greater risk of incisional hernia with morbidly obese than steroid-dependent patients and low recurrence with prefascial polypropylene mesh. Am J Surg 171:80–84. doi:10.1016/S0002-9610(99)80078-6 CrossRefPubMed

Varela JE, Hinojosa M, Nguyen N (2009) Correlations between intra-abdominal pressure and obesity-related co-morbidities. Surg Obes Relat Dis 5:524–528. doi:10.1016/j.soard.2009.04.003 CrossRefPubMed

Szczesny W, Bodnar M, Dabrowiecki S, Szmytkowski J, Marszałek A (2013) Histologic and immunohistochemical studies of rectus sheath in obese patients. J Surg Res 180:260–265. doi:10.1016/j.jss.2012.05.008 CrossRefPubMed

Klinge U, Si ZY, Zheng H, Schumpelick V, Bhardwaj RS, Klosterhalfen B (2001) Collagen I/III and matrix metalloproteinases (MMP) 1 and 13 in the fascia of patients with incisional hernias. J Invest Surg 14:47–54CrossRefPubMed

Veljkovic R, Protic M, Gluhovic A, Potic Z, Milosevic Z, Stojadinovic A (2010) Prospective clinical trial of factors predicting the early development of incisional hernia after midline laparotomy. J Am Coll Surg 210:210–219. doi:10.1016/j.jamcollsurg.2009.10.013 CrossRefPubMed

Heniford BT, Park A, Ramshaw BJ, Voeller G (2003) Laparoscopic repair of ventral hernias: nine years’ experience with 850 consecutive hernias. Ann Surg 238:391–399. doi:10.1097/01.sla.0000086662.49499.ab (discussion 399–400) PubMedPubMedCentral

Rao RS, Gentileschi P, Kini SU (2011) Management of ventral hernias in bariatric surgery. Surg Obes Relat Dis 7:110–116. doi:10.1016/j.soard.2010.09.021 CrossRefPubMed

Praveen Raj P, Senthilnathan P, Kumaravel R, Rajpandian S, Rajan PS, Anand Vijay N, Palanivelu C (2012) Concomitant laparoscopic ventral hernia mesh repair and bariatric surgery: a retrospective study from a tertiary care center. Obes Surg 22:685–689. doi:10.1007/s11695-012-0614-3 CrossRefPubMed

10.

Carbonell AM, Criss CN, Cobb WS, Novitsky YW, Rosen MJ (2013) Outcomes of synthetic mesh in contaminated ventral hernia repairs. J Am Coll Surg. doi:10.1016/j.jamcollsurg.2013.07.382 PubMed

11.

Morris-Stiff GJ, Hughes LE (1998) The outcomes of nonabsorbable mesh placed within the abdominal cavity: literature review and clinical experience. J Am Coll Surg 186:352–367CrossRefPubMed

12.

Breuing K, Butler CE, Ferzoco S, Franz M, Hultman CS, Kilbridge JF, Rosen M, Silverman RP, Vargo D (2010) Incisional ventral hernias: review of the literature and recommendations regarding the grading and technique of repair. Surgery 148:544–558. doi:10.1016/j.surg.2010.01.008 CrossRefPubMed

13.

Eid GM, Mattar SG, Hamad G, Cottam DR, Lord JL, Watson A, Dallal RM, Schauer PR, Dallal M (2004) Repair of ventral hernias in morbidly obese patients undergoing laparoscopic gastric bypass should not be deferred. Surg Endosc 18:207–210. doi:10.1007/s00464-003-8915-1 CrossRefPubMed

14.

Chan DL, Talbot ML, Chen Z, Kwon SCM (2014) Simultaneous ventral hernia repair in bariatric surgery. ANZ J Surg 84:581–583. doi:10.1111/ans.12174 CrossRefPubMed

15.

CDC—Table 7-8-9-10: SSI Guideline, 1999—HICPAC

16.

Spaniolas K, Kasten KR, Mozer AB, Sippey ME, Chapman WHH, Pories WJ, Pender JR (2015) Synchronous Ventral Hernia Repair in Patients Undergoing Bariatric Surgery. Obes Surg 25:1864–1868. doi:10.1007/s11695-015-1625-7 CrossRefPubMed

17.

Cleveland RD, Zitsch RP, Laws HL (1989) Incisional closure in morbidly obese patients. Am Surg 55:61–63PubMed

18.

Regnard JF, Hay JM, Rea S, Fingerhut A, Flamant Y, Maillard JN (1988) Ventral incisional hernias: incidence, date of recurrence, localization and risk factors. Ital J Surg Sci 18:259–265PubMed

19.

Mingoli A, Puggioni A, Sgarzini G, Luciani G, Corzani F, Ciccarone F, Baldassarre E, Modini C (1998) Incidence of incisional hernia following emergency abdominal surgery. Ital J Gastroenterol Hepatol 31:449–453

20.

Pikarsky AJ, Saida Y, Yamaguchi T, Martinez S, Chen W, Weiss EG, Nogueras JJ, Wexner SD (2002) Is obesity a high-risk factor for laparoscopic colorectal surgery? Surg Endosc 16:855–858. doi:10.1007/s004640080069 CrossRefPubMed

21.

Robinson SP, Hirtle M, Imbrie JZ, Moore MM (1998) The mechanics underlying laparoscopic intra-abdominal surgery for obese patients. J Laparoendosc Adv Surg Tech A 8:11–18CrossRefPubMed

22.

Newcomb WL, Polhill JL, Chen AY, Kuwada TS, Gersin KS, Getz SB, Kercher KW, Heniford BT (2008) Staged hernia repair preceded by gastric bypass for the treatment of morbidly obese patients with complex ventral hernias. Hernia 12:465–469. doi:10.1007/s10029-008-0381-1 CrossRefPubMed

23.

Luján JA, Frutos MD, Hernández Q, Liron R, Cuenca JR, Valero G, Parrilla P (2004) Laparoscopic versus open gastric bypass in the treatment of morbid obesity: a randomized prospective study. Ann Surg 239:433–437CrossRefPubMedPubMedCentral

24.

Flancbaum L, Choban PS (1998) Surgical implications of obesity. Annu Rev Med 49:215–234. doi:10.1146/annurev.med.49.1.215 CrossRefPubMed

25.

Israelsson LA, Jonsson T (1997) Overweight and healing of midline incisions: the importance of suture technique. Eur J Surg 163:175–180PubMed

26.

Hu H, Li N, Yngen M, Ostenson C-G, Wallén NH, Hjemdahl P (2004) Enhanced leukocyte-platelet cross-talk in type 1 diabetes mellitus: relationship to microangiopathy. J Thromb Haemost 2:58–64CrossRefPubMed

27.

Latham R, Lancaster AD, Covington JF, Pirolo JS, Thomas CS (2001) The association of diabetes and glucose control with surgical-site infections among cardiothoracic surgery patients. Infect Control Hosp Epidemiol 22:607–612. doi:10.1086/501830 CrossRefPubMed

28.

Krinsley JS (2004) Effect of an intensive glucose management protocol on the mortality of critically ill adult patients. Mayo Clin Proc 79:992–1000. doi:10.4065/79.8.992 CrossRefPubMed

29.

Rios A, Rodriguez JM, Munitiz V, Alcaraz P, Pérez D, Parrilla P (2001) Factors that affect recurrence after incisional herniorrhaphy with prosthetic material. Eur J Surg 167:855–859. doi:10.1080/11024150152717706 CrossRefPubMed

30.

Stremitzer S, Bachleitner-Hofmann T, Gradl B, Gruenbeck M, Bachleitner-Hofmann B, Mittlboeck M, Bergmann M (2010) Mesh graft infection following abdominal hernia repair: risk factor evaluation and strategies of mesh graft preservation. A retrospective analysis of 476 operations. World J Surg 34:1702–1709. doi:10.1007/s00268-010-0543-z CrossRefPubMed

31.

Cozacov Y, Szomstein S, Safdie FM, Lo Menzo E, Rosenthal R (2014) Is the use of prosthetic mesh recommended in severely obese patients undergoing concomitant abdominal wall hernia repair and sleeve gastrectomy? J Am Coll Surg 218:358–362. doi:10.1016/j.jamcollsurg.2013.12.008 CrossRefPubMed

32.

Kelly ME, Behrman SW (2002) The safety and efficacy of prosthetic hernia repair in clean-contaminated and contaminated wounds. Am Surg 68:524–528 (discussion 528–529) PubMed

33.

Birolini C, Utiyama EM, Rodrigues AJ, Birolini D (2000) Elective colonic operation and prosthetic repair of incisional hernia: does contamination contraindicate abdominal wall prosthesis use? J Am Coll Surg 191:366–372CrossRefPubMed

34.

Stringer RA, Salameh JR (2005) Mesh herniorrhaphy during elective colorectal surgery. Hernia 9:26–28. doi:10.1007/s10029-004-0274-x CrossRefPubMed

35.

Schuster R, Curet MJ, Alami RS, Morton JM, Wren SM, Safadi BY (2006) Concurrent gastric bypass and repair of anterior abdominal wall hernias. Obes Surg 16:1205–1208. doi:10.1381/096089206778392374 CrossRefPubMed

36.

Praveenraj P, Gomes RM, Kumar S, Senthilnathan P, Parthasarathi R, Rajapandian S, Palanivelu C (2015) Concomitant bariatric surgery with laparoscopic intra-peritoneal onlay mesh repair for recurrent ventral hernias in morbidly obese patients: an evolving standard of care. Obes Surg. doi:10.1007/s11695-015-1875-4

37.

Raziel A, Sakran N, Szold A, Goitein D (2014) Concomitant bariatric and ventral/incisional hernia surgery in morbidly obese patients. Surg Endosc 28:1209–1212. doi:10.1007/s00464-013-3310-z CrossRefPubMed

38.

Sukeik M, Alkari B, Ammori BJ (2007) Abdominal wall hernia during laparoscopic gastric bypass: a serious consideration. Obes Surg 17:839–842CrossRefPubMed

39.

Bonatti H, Hoeller E, Kirchmayr W, Muhlmann G, Zitt M, Aigner F, Weiss H, Klaus A (2004) Ventral hernia repair in bariatric surgery. Obes Surg 14:655–658. doi:10.1381/096089204323093444 CrossRefPubMed

Title: Outcomes of concomitant ventral hernia repair performed during bariatric surgery
Authors: G. Sharma
M. Boules
S. Punchai
A. Strong
D. Froylich
N. H. Zubaidah
C. O’Rourke
S. A. Brethauer
J. Rodriguez
K. El-Hayek
M. Kroh
Publication date: 01-04-2017
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 4/2017
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-016-5143-z

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Outcomes of concomitant ventral hernia repair performed during bariatric surgery

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 4/2017

Weight regain following RYGB can be effectively treated using a combination of endoscopic suturing and sclerotherapy

Modified single-port non-intubated video-assisted thoracoscopic decortication in high-risk parapneumonic empyema patients

Surgical anatomy of the supracarinal esophagus based on a minimally invasive approach: vascular and nervous anatomy and technical steps to resection and lymphadenectomy

Is bariatric surgery safe in the elderly population?

A new innovative laparoscopic fundoplication training simulator with a surgical skill validation system

Impact of adherence to care pathway interventions on recovery following bowel resection within an established enhanced recovery program