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01-06-2021 | Abdominoplasty | Original Article

Management of ventral hernia in patients with BMI > 30 Kg/m²: outcomes based on an institutional algorithm

Authors: S. J. Baig, P. Priya

Published in: Hernia | Issue 3/2021

Abstract

Introduction

Management of ventral hernia in obese is a complex problem. The methods of weight loss, alternatives if the patient cannot undergo bariatric surgery, timing, and type of hernia surgery lacks clarity and are dependent on resources and expertise. There is a need for algorithms based on local population and expertise. In this paper, we present the outcomes of our institutional algorithm.

Methods

It was a retrospective analysis of prospectively collected data. Patients with body mass index (BMI) > 30Kg/m² were included to undergo surgery as per algorithm taking into account (a) presentation (symptomatic vs asymptomatic), (b) hernia characteristics (defect width, site, reducibility), and (c) obesity characteristics (BMI, subcutaneous fat, android vs gynecoid). Data on age, BMI, comorbidities, tobacco consumption, hernia width, location, contents, previous surgery, intraoperative parameters (the type of surgery, mesh, drain, fixation), and outcomes (seroma, hematoma, infection, recurrence) were collected.

Results

A total of 50 patients underwent treatment as per the algorithm. Mean BMI was 36.6 ± 7.3 kg/m². The mean follow-up was 17.6 ± 7.2 months. The mean defect width was 4.8 ± 2.9 cm. There were two (4%) recurrences in patients who underwent an anatomical repair under emergency conditions. None of the patients who underwent an elective repair had a recurrence. Total surgical site occurrence was 12% and surgical site occurrence requiring procedural intervention was 8%. There was one (2%) mortality on postoperative day 7 due to myocardial infarction.

Conclusion

The algorithm has shown encouraging results in the short-to-medium term. Long-term evaluation with a higher number of patients is needed to confirm its usefulness.

Lau B, Kim H, Haigh PI, Tejirian T (2012) Obesity increases the odds of acquiring and incarcerating noninguinal abdominal wall hernias. Am Surg 78(10):1118–1121CrossRefPubMed

Tsereteli Z, Pryor BA, Heniford BT et al (2008) Laparoscopic ventral hernia repair (LVHR) in morbidly obese patients. Hernia 12:233–238. https://doi.org/10.1007/s10029-007-0310-8CrossRefPubMed

Kanters AE, Krpata DM, Blatnik JA et al (2012) Modified hernia grading scale to stratify surgical site occurrence after open ventral hernia repairs. J Am Coll Surg 215:787–793. https://doi.org/10.1016/j.jamcollsurg.2012.08.012CrossRefPubMed

Goodenough CJ, Ko TC, Kao LS et al (2015) Development and validation of a risk stratification score for ventral incisional hernia after abdominal surgery: Hernia expectation rates in intra-abdominal surgery (The HERNIA project). J Am Coll Surg 220(4):405–413. https://doi.org/10.1016/j.jamcollsurg.2014.12.027CrossRefPubMedPubMedCentral

Yahchouchy-Chouillard E, Aura T, Picone O et al (2003) Incisional hernias: I Related risk factors. Dig Surg 20:3–9CrossRefPubMed

Lo ME, Hinojosa M, Carbonell A et al (2018) American Society for Metabolic and Bariatric Surgery and American Hernia Society consensus guideline on bariatric surgery and hernia surgery. Surg Obes Relat Dis 14:1221–1232. https://doi.org/10.1016/j.soard.2018.07.005CrossRef

Henriksen NA, Bisgaard T, Helgstrand F (2020) Smoking and obesity are associated with increased readmission after elective repair of small primary ventral hernias: A nationwide database study. Surg (United States). https://doi.org/10.1016/j.surg.2020.04.012CrossRef

Park H, de Virgilio C, Kim DY et al (2020) Effects of smoking and different BMI cutoff points on surgical site infection after elective open ventral hernia repair. Hernia. https://doi.org/10.1007/s10029-020-02190-xCrossRefPubMed

Eid GM, Wikiel KJ, Entabi F, Saleem M (2013) Ventral hernias in morbidly obese patients: a suggested algorithm for operative repair. Obes Surg 23:703–709. https://doi.org/10.1007/s11695-013-0883-5CrossRefPubMed

10.

Levi B, Zhang P, Lisiecki J et al (2014) Use of morphometric assessment of body composition to quantify risk of surgical-site infection in patients undergoing component separation ventral hernia repair. 2014 Apr;133(4):559e-66e. https://doi.org/10.1097/PRS.0000000000000009. PMID: 24675208.CrossRefPubMed

11.

Krivan MS, Giorga A, Barreca M et al (2019) Concomitant ventral hernia repair and bariatric surgery: a retrospective analysis from a UK-based bariatric center. Surg Endosc 33:705–710CrossRefPubMed

12.

Zavlin D, Jubbal KT, Van Eps JL et al (2018) Safety of open ventral hernia repair in high-risk patients with metabolic syndrome: a multi-institutional analysis of 39,118 cases. Surg Obes Relat Dis 14:206–213. https://doi.org/10.1016/j.soard.2017.09.521CrossRefPubMed

13.

Nishida C (2004) Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 363:157–163CrossRef

14.

Misra A, Chowbey P, Makkar BM et al (2009) Consensus statement for diagnosis of obesity, abdominal obesity and the metabolic syndrome for asian indians and recommendations for physical activity, medical and surgical management. J Assoc Physicians India 57:163–170PubMed

15.

Novitsky YW, Elliott HL, Orenstein SB, Rosen MJ (2012) Transversus abdominis muscle release: a novel approach to posterior component separation during complex abdominal wall reconstruction. Am J Surg 204:709–716. https://doi.org/10.1016/j.amjsurg.2012.02.008CrossRefPubMed

16.

Belyansky I, Daes J, Radu VG et al (2017) A novel approach using the enhanced-view totally extraperitoneal (eTEP) technique for laparoscopic retromuscular hernia repair. Surg Endosc. https://doi.org/10.1007/s00464-017-5840-2CrossRefPubMed

17.

Baig S, Priya P (2018) Extended totally extraperitoneal repair (eTEP) for ventral hernias: Short-term results from a single centre. J Minim Access Surg. https://doi.org/10.4103/jmas.JMAS_29_18CrossRef

18.

Berriós-Torres SI, Umscheid CA, Bratzler DW et al (2017) Centers for disease control and prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg 152:784–791CrossRefPubMed

19.

Bittner R, Bain K, Bansal VK et al (2019) Update of Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (International Endohernia Society (IEHS))—Part A. Surg Endosc 33:3069–3139. https://doi.org/10.1007/s00464-019-06907-7CrossRefPubMedPubMedCentral

20.

Heniford BT, Park A, Ramshaw BJ et al (2003) Laparoscopic repair of ventral hernias: nine years’ experience with 850 consecutive hernias. Ann Surg 238(3):391–399. https://doi.org/10.1097/01.sla.0000086662.49499.abCrossRefPubMedPubMedCentral

21.

Sartelli M, Coccolini F, van Ramshorst GH et al (2013) WSES guidelines for emergency repair of complicated abdominal wall hernias. World J Emerg Surg 8:50. https://doi.org/10.1186/1749-7922-8-50CrossRefPubMedPubMedCentral

22.

Baig SJ, Priya P (2018) Tailored approach to ventral hernia—our proposed algorithm. Indian J Surg 80:205–206CrossRefPubMedPubMedCentral

23.

Novitsky YW, Cobb WS, Kercher KW et al (2006) Laparoscopic ventral hernia repair in obese patients: A new standard of care. Arch Surg 141:57–61. https://doi.org/10.1001/archsurg.141.1.57CrossRefPubMed

24.

Giordano SA, Garvey PB, Baumann DP et al (2017) The impact of body mass index on abdominal wall reconstruction outcomes: A comparative study. Plast Reconstr Surg 139:1234–1244. https://doi.org/10.1097/PRS.0000000000003264CrossRefPubMedPubMedCentral

25.

Warren JA, Epps M, Debrux C et al (2015) Surgical site occurrences of simultaneous panniculectomy and incisional hernia repair. Am Surg 81:764–769CrossRefPubMed

26.

Espinosa-de-los-Monteros A, Avendaño-Peza H, Gómez-Arcive Z et al (2016) Total abdominal wall reconstruction with component separation, reinforcement, and vertical abdominoplasty in patients with complex ventral hernias. Aesthetic Plast Surg 40:387–394. https://doi.org/10.1007/s00266-016-0628-7CrossRefPubMed

27.

Giordano S, Garvey PB, Baumann DP et al (2017) Concomitant panniculectomy affects wound morbidity but not hernia recurrence rates in abdominal wall reconstruction: a propensity score analysis. Plast Reconstr Surg 140:1263–1273. https://doi.org/10.1097/PRS.0000000000003855CrossRefPubMed

28.

Eid GM, Mattar SG, Hamad G et al (2004) Repair of ventral hernias in morbidly obese patients undergoing laparoscopic gastric bypass should not be deferred. Surg Endosc Other Interv Tech 18:207–210CrossRef

29.

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

30.

Bonatti H, Hoeller E, Kirchmayr W et al (2004) Ventral hernia repair in bariatric surgery. Obes Surg 14:655–658. https://doi.org/10.1381/096089204323093444CrossRefPubMed

31.

Schuster R, Curet MJ, Alami RS et al (2006) Concurrent gastric bypass and repair of anterior abdominal wall hernias. Obes Surg 16:1205–1208. https://doi.org/10.1381/096089206778392374CrossRefPubMed

32.

Newcomb WL, Polhill JL, Chen AY et al (2008) Staged hernia repair preceded by gastric bypass for the treatment of morbidly obese patients with complex ventral hernias. Hernia 12:465–469. https://doi.org/10.1007/s10029-008-0381-1CrossRefPubMed

33.

Praveen Raj P, Bhattacharya S, Saravana Kumar S et al (2019) Morbid obesity with ventral hernia: is concomitant bariatric surgery with laparoscopic ventral hernia mesh repair the best approach? An experience of over 150 cases. Surg Obes Relat Dis 15:1098–1103. https://doi.org/10.1016/j.soard.2019.04.027CrossRefPubMed

34.

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

35.

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. https://doi.org/10.1007/s00464-013-3310-zCrossRefPubMed

36.

Sharma G, Boules M, Punchai S et al (2017) Outcomes of concomitant ventral hernia repair performed during bariatric surgery. Surg Endosc 31:1573–1582. https://doi.org/10.1007/s00464-016-5143-zCrossRefPubMed

37.

Lazzati A, Nassif GB, Paolino L (2018) Concomitant ventral hernia repair and bariatric surgery: a systematic review. Obes Surg 28:2949–2955CrossRefPubMed

38.

Birgisson G, Park AE, Mastrangelo MJ et al (2001) Obesity and laparoscopic repair of ventral hernias. Surg Endosc 15:1419–1422. https://doi.org/10.1007/s004640080077CrossRefPubMed

39.

Sugerman HJ, Kellum JM, Reines HD et al (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. https://doi.org/10.1016/S0002-9610(99)80078-6CrossRefPubMed

40.

Bower CE, Reade CC, Kirby LW, Roth JS (2004) Complications of laparoscopic incisional-ventral hernia repair: The experience of a single institution. Surg Endosc Other Interv Tech 18:672–675

41.

Raftopoulos I, Courcoulas AP (2007) Outcome of laparoscopic ventral hernia repair in morbidly obese patients with a body mass index exceeding 35 kg/m2. Surg Endosc Other Interv Tech 21:2293–2297. https://doi.org/10.1007/s00464-007-9406-6CrossRef

42.

Olmi S, Uccelli M, Cesana GC et al (2020) Laparoscopic ventral hernia repair in bariatric patients: the role of defect size and deferred repair. Obes Surg. https://doi.org/10.1007/s11695-020-04747-2CrossRefPubMedPubMedCentral

43.

Schlosser KA, Arnold MR, Otero J et al (2019) Deciding on optimal approach for ventral hernia repair: laparoscopic or open. J Am Coll Surg 228:54–65. https://doi.org/10.1016/j.jamcollsurg.2018.09.004CrossRefPubMed

44.

Vilallonga R, Fort JM, Gonzalez O et al (2011) Management of patients with hernia or incisional hernia undergoing surgery for morbid obesity. J Obes. https://doi.org/10.1155/2011/860942CrossRefPubMed

Title: Management of ventral hernia in patients with BMI > 30 Kg/m2: outcomes based on an institutional algorithm
Authors: S. J. Baig
P. Priya
Publication date: 01-06-2021
Publisher: Springer Paris
Keywords: Abdominoplasty
Obesity
Obesity
Seroma
Abdominoplasty
Bariatric Surgery
Bariatric Surgery
Abdominoplasty
Hernia Surgery
Published in: Hernia / Issue 3/2021
Print ISSN: 1265-4906
Electronic ISSN: 1248-9204
DOI: https://doi.org/10.1007/s10029-020-02318-z

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Management of ventral hernia in patients with BMI > 30 Kg/m²: outcomes based on an institutional algorithm

Abstract

Introduction

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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