Top

Surgical Endoscopy

Published in:

01-10-2021 | Obesity | 2020 SAGES Oral

Impact of Body Mass Index (BMI) on perioperative outcomes following minimally invasive retromuscular abdominal wall reconstruction: a comparative analysis

Authors: Alex Addo, Richard Lu, Andrew Broda, Philip George, Nick Huerta, Adrian Park, H. Reza Zahiri, Igor Belyansky

Published in: Surgical Endoscopy | Issue 10/2021

Abstract

Background

Morbidity and recurrence rates are higher in obese patients undergoing open abdominal wall reconstruction (AWR). Historically, body mass index (BMI) ≥ 40 has served as a relative contraindication to open AWR. The purpose of this study is to evaluate the impact of minimally invasive surgery (MIS) on outcomes after AWR for higher versus lower BMI patients.

Methods

A retrospective review of a prospectively maintained database was conducted of all patients who underwent MIS AWR between September 2015 and April 2019 at our institution. Patients were subdivided into two groups based on their BMI: BMI ≤ 35 kg/m² and BMI > 35 kg/m². Patient demographics and perioperative data were evaluated using univariate and multivariate analysis.

Results

461 patients were identified and divided into two groups: BMI ≤ 35 (n = 310) and BMI > 35 (n = 151). The two groups were similar in age (BMI ≤ 35: 56.3 ± 14.1 years vs. BMI > 35: 54.4 ± 11.9, p = .154). BMI > 35 group had more patients with ASA score of 3 (81% vs. 32%, p < .001) and comorbid conditions such as hypertension (70% vs. 45%, p < .001), diabetes mellitus (32% vs. 15%, p < .001), and history of recurrent abdominal wall hernia (34% vs. 23%, p = .008). BMI > 35 group underwent a robotic approach at higher rates (74% vs. 45%, p < .001). Patients who underwent a Rives–Stoppa repair from the higher BMI cohort also had a larger defect size (5.6 ± 2.4 cm vs. 6.7 ± 2.4 cm, p = .004). However, there were no differences in defect size in patients who underwent a transversus abdominus release (BMI ≤ 35: 9.7 ± 4.9 cm vs. BMI > 35: 11.1 ± 4.6 cm, p = .069). Both groups benefited similarly from a short length of stay, similar hospital charges, and lower postoperative complications.

Conclusion

Initial findings of our data support the benefits of elective MIS approach to AWR for patients with higher BMI. These patients derive similar benefits, such as faster recovery with low recurrence rates, when compared to lower BMI patients, while avoiding preoperative hernia incarceration, postoperative wound complications, and hernia recurrences. Future follow-up is required to establish long-term perioperative and quality of life outcomes in this patient cohort.

Poulose BK, Shelton J, Phillips S et al (2012) Epidemiology and cost of ventral hernia repair: making the case for hernia research. Hernia. https://doi.org/10.1007/s10029-011-0879-9CrossRefPubMed

Birgisson G, Park AE, Mastrangelo MJ, Witzke DB, Chu UB (2001) Obesity and laparoscopic repair of ventral hernias. Surg Endosc. https://doi.org/10.1007/s004640080077CrossRefPubMed

Danzig MR, Stey AM, Yin SS, Qiu S, Divino CM (2016) Patient profiles and outcomes following repair of irreducible and reducible Ventral Wall Hernias. Hernia. https://doi.org/10.1007/s10029-015-1381-6CrossRefPubMed

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. https://doi.org/10.1016/j.jamcollsurg.2014.12.027CrossRefPubMedPubMedCentral

Owei L, Swendiman RA, Kelz RR, Dempsey DT, Dumon KR (2017) Impact of body mass index on open ventral hernia repair: a retrospective review. Surg (United States) 162(6):1320–1329. https://doi.org/10.1016/j.surg.2017.07.025CrossRef

Al Chalabi H, Larkin J, Mehigan B, McCormick P (2015) A systematic review of laparoscopic versus open abdominal incisional hernia repair, with meta-analysis of randomized controlled trials. Int J Surg. https://doi.org/10.1016/j.ijsu.2015.05.050CrossRefPubMed

DeMaria EJ, Moss JM, Sugerman HJ (2000) Laparoscopic intraperitoneal polytetrafluoroethylene (PTFE) prosthetic patch repair of ventral hernia: prospective comparison to open prefascial polypropylene mesh repair. Surg Endosc. https://doi.org/10.1007/s004640020013CrossRefPubMed

Fekkes JF, Velanovich V (2015) Amelioration of the effects of obesity on short-term postoperative complications of laparoscopic and open ventral hernia repair. Surg Laparosc Endosc Percutaneous Tech 25(2):151–157. https://doi.org/10.1097/SLE.0000000000000100CrossRef

Heniford BT, Park A, Ramshaw BJ, Voeller G, Hunter JG, Fitzgibbons RJ (2003) Laparoscopic repair of ventral hernias: nine years’ experience with 850 consecutive hernias. Ann Surg. https://doi.org/10.1097/01.sla.0000086662.49499.abCrossRefPubMedPubMedCentral

10.

Belyansky I, Daes J, Radu VG et al (2018) A novel approach using the enhanced-view totally extraperitoneal (eTEP) technique for laparoscopic retromuscular hernia repair. Surg Endosc 32(3):1525–1532. https://doi.org/10.1007/s00464-017-5840-2CrossRefPubMed

11.

Mueck KM, Holihan JL, Mo J et al (2017) Computed tomography findings associated with the risk for emergency ventral hernia repair. Am J Surg 214(1):42–46. https://doi.org/10.1016/j.amjsurg.2016.09.035CrossRefPubMed

12.

Beadles CA, Meagher AD, Charles AG (2015) Trends in emergent hernia repair in the united states. JAMA Surg 150(3):194–200. https://doi.org/10.1001/jamasurg.2014.1242CrossRefPubMed

13.

Kao AM, Huntington CR, Otero J et al (2018) Emergent laparoscopic ventral hernia repairs. J Surg Res 232:497–502. https://doi.org/10.1016/j.jss.2018.07.034CrossRefPubMed

14.

Azin A, Hirpara D, Jackson T et al (2019) Emergency laparoscopic and open repair of incarcerated ventral hernias: a multi-institutional comparative analysis with coarsened exact matching. Surg Endosc. https://doi.org/10.1007/s00464-018-6573-6CrossRefPubMed

15.

Tolino MJ, Tripoloni DE, Ratto R, García MI (2009) Infections associated with prosthetic repairs of abdominal wall hernias: pathology, management and results. Hernia. https://doi.org/10.1007/s10029-009-0541-yCrossRefPubMed

16.

Weltz AS, Sibia US, Reza Zahiri H, Schoeneborn A, Park A, Belyansky I (2017) Operative outcomes after open abdominal wall reconstruction with retromuscular mesh fixation using fibrin glue versus transfascial sutures. Am Surg 83:937–942CrossRef

17.

Lu R, Addo A, Ewart Z et al (2019) Comparative review of outcomes: laparoscopic and robotic enhanced-view totally extraperitoneal (eTEP) access retrorectus repairs. Surg Endosc. https://doi.org/10.1007/s00464-019-07132-yCrossRefPubMedPubMedCentral

18.

Belyansky I, Weltz AS, Sibia US et al (2018) The trend toward minimally invasive complex abdominal wall reconstruction: is it worth it? Surg Endosc. https://doi.org/10.1007/s00464-017-5850-0CrossRefPubMed

19.

Rosen MJ, Aydogdu K, Grafmiller K, Petro CC, Faiman GH, Prabhu A (2015) A multidisciplinary approach to medical weight loss prior to complex abdominal wall reconstruction: is it feasible? J Gastrointest Surg. https://doi.org/10.1007/s11605-015-2856-6CrossRefPubMed

Title: Impact of Body Mass Index (BMI) on perioperative outcomes following minimally invasive retromuscular abdominal wall reconstruction: a comparative analysis
Authors: Alex Addo
Richard Lu
Andrew Broda
Philip George
Nick Huerta
Adrian Park
H. Reza Zahiri
Igor Belyansky
Publication date: 01-10-2021
Publisher: Springer US
Keywords: Obesity
Obesity
Minimally Invasive Surgery
Published in: Surgical Endoscopy / Issue 10/2021
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-020-08069-3

At a glance: The STEP trials

Springer Medicine

Impact of Body Mass Index (BMI) on perioperative outcomes following minimally invasive retromuscular abdominal wall reconstruction: a comparative analysis

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 10/2021

The impact of minimally invasive surgery on hospital readmissions, emergency department visits and functional recovery after distal pancreatectomy

Endoscopic submucosal dissection using a detachable assistant robot: a comparative in vivo feasibility study (with video)

Using a standardized intra-operative endoflip protocol during fundoplication to identify factors that affect distensibility

Magnetic anchoring and guidance-assisted endoscopic irreversible electroporation for gastric mucosal ablation: a preclinical study in canine model

Totally extra-peritoneal repair versus trans-abdominal pre-peritoneal repair for the laparoscopic surgical management of sportsman’s hernia: A systematic review and meta-analysis

Use of right colon vaginoplasty in gender affirming surgery: proposed advantages, review of technique, and outcomes