Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Hernia
Published in: Hernia 1/2021

01-02-2021 | Obesity | Original Article

Propensity score matching analysis of short-term outcomes in robotic ventral hernia repair for patients with a body mass index above and below 35 kg/m2

Authors: O. Y. Kudsi, F. Gokcal, K. Chang

Published in: Hernia | Issue 1/2021

Login to get access

Abstract

Objective

The purpose of this study was to compare perioperative complications after robotic ventral hernia repair between patients with non-obese, class-I obesity with those with class-II or class-III obesity.

Background

Obesity is a growing epidemic and is considered as an independent risk factor for a multitude of perioperative complications. Laparoscopic ventral hernia repair has been shown as a safe and feasible approach in population with elevated body mass index (BMI). This study compared overall perioperative complications and surgical site events (SSEs) after robotic ventral hernia repair (RVHR) between patients with a BMI 35 kg/m2 or more and patients with a BMI lower than 35 kg/m2.

Methods

A retrospective cohort analysis was conducted with one-to-one propensity score matching (PSM) method to obtain balanced groups evaluating patients who underwent RVHR between February 2012 and June 2019 in a single institution. Preoperative, intraoperative, and postoperative variables were reviewed. Postoperative complications and morbidity were assessed using the Clavien–Dindo classification and comprehensive complication index (CCI®) score system. SSEs were compared.

Results

Our unmatched sample included 526 patients with an average BMI of 31.2 kg/m2. Of these, 29.8% (n = 160) patients were in high-BMI group (range 35–59.2). After PSM, 142 patients were assigned to each group. Both groups experienced similar complication rates during 90 days. Clavien–Dindo grades, CCI® scores, and SSEs did not differ between the two groups.

Conclusion

RVHR in class-II and class-III obese patients is safe, feasible, and effective. In addition to this, it has comparable short-term outcomes with those non-obese and class-I obese patients.
Literature
1.
Blackstone RP, Epidemiology, measurement, and cost of obesity (2016) In: Obesity, Springer, pp 1-22
2.
Novitsky YW, Cobb WS, Kercher KW et al (2006) Laparoscopic ventral hernia repair in obese patients: a new standard of care. Arch Surg 141:57–61CrossRef
3.
Flancbaum L, Choban PS (1998) Surgical implications of obesity. Annu Rev Med 49:215–234CrossRef
4.
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 21:2293–2297CrossRef
5.
Froylich D, Segal M, Weinstein A et al (2016) Laparoscopic versus open ventral hernia repair in obese patients: a long-term follow-up. Surg Endosc 30:670–675CrossRef
6.
Birgisson G, Park AE, Mastrangelo MJ Jr et al (2001) Obesity and laparoscopic repair of ventral hernias. Surg Endosc 15:1419–1422CrossRef
7.
Tsereteli Z, Pryor BA, Heniford BT et al (2008) Laparoscopic ventral hernia repair (LVHR) in morbidly obese patients. Hernia 12:233–238CrossRef
8.
Ching SS, Sarela AI, Dexter SP et al (2008) Comparison of early outcomes for laparoscopic ventral hernia repair between nonobese and morbidly obese patient populations. Surg Endosc 22:2244–2250CrossRef
9.
Rosen MJ, Aydogdu K, Grafmiller K et al (2015) A multidisciplinary approach to medical weight loss prior to complex abdominal wall reconstruction: is it feasible? J Gastrointest Surg 19:1399–1406CrossRef
10.
Marx L, Raharimanantsoa M, Mandala S et al (2014) Laparoscopic treatment of incisional and primary ventral hernia in morbidly obese patients with a BMI over 35. Surg Endosc 28:3310–3314CrossRef
11.
Lindmark M, Strigard K, Lowenmark T et al (2018) Risk factors for surgical complications in ventral hernia repair. World J Surg 42:3528–3536CrossRef
12.
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 139:1234–1244CrossRef
13.
von Elm E, Altman DG, Egger M et al (2007) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies STROBE statement. Ann Intern Med 147:573–577CrossRef
14.
Muysoms FE, Miserez M, Berrevoet F et al (2009) Classification of primary and incisional abdominal wall hernias. Hernia 13:407–414CrossRef
15.
Gokcal F, Morrison S, Kudsi OY (2019) Short-term comparison between preperitoneal and intraperitoneal onlay mesh placement in robotic ventral hernia repair. Hernia 23:957–967CrossRef
16.
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRef
17.
Slankamenac K, Graf R, Barkun J et al (2013) The comprehensive complication index: a novel continuous scale to measure surgical morbidity. Ann Surg 258:1–7CrossRef
18.
Petro CC, Novitsky YW (2016) Classification of hernias. In: hernia surgery, Springer, Berlin, pp 15–21
19.
20.
Gokcal F, Morrison S, Kudsi OY (2019) Robotic retromuscular ventral hernia repair and transversus abdominis release: short-term outcomes and risk factors associated with perioperative complications. Hernia 23:375–385CrossRef
21.
Faul F, Erdfelder E, Lang AG et al (2007) G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 39:175–191CrossRef
22.
Thoemmes F(2012) Propensity score matching in SPSS. Tubingen, University of Tubingen
23.
Hansen BB, Bowers J (2008) Covariate balance in simple, stratified and clustered comparative studies. Stat Sci 23:219–236CrossRef
24.
Iacus S, King G, Porro G (2009) CEM: Software for coarsened exact matching. J Stat Softw 30:1–27CrossRef
25.
Liang MK, Holihan JL, Itani K et al (2017) Ventral hernia management: expert consensus guided by systematic review. Ann Surg 265:80–89CrossRef
26.
Tastaldi L, Krpata DM, Prabhu AS et al (2019) The effect of increasing body mass index on wound complications in open ventral hernia repair with mesh. Am J Surg 218:560–566CrossRef
27.
Kaoutzanis C, Leichtle SW, Mouawad NJ et al (2015) Risk factors for postoperative wound infections and prolonged hospitalization after ventral/incisional hernia repair. Hernia 19:113–123CrossRef
28.
Mrdutt MM, Munoz-Maldonado Y, Regner JL (2016) Impact of obesity on postoperative 30-day outcomes in emergent open ventral hernia repairs. Am J Surg 212:1068–1075CrossRef
29.
Regner JL, Mrdutt MM, Munoz-Maldonado Y (2015) Tailoring surgical approach for elective ventral hernia repair based on obesity and National Surgical Quality Improvement Program outcomes. Am J Surg 210:1024–1029CrossRef
30.
Owei L, Swendiman RA, Kelz RR et al (2017) Impact of body mass index on open ventral hernia repair: a retrospective review. Surgery 162:1320–1329CrossRef
31.
Pernar LIM, Pernar CH, Dieffenbach BV et al (2017) What is the BMI threshold for open ventral hernia repair? Surg Endosc 31:1311–1317CrossRef
32.
Sauerland S, Walgenbach M, Habermalz B, et al (2011) Laparoscopic versus open surgical techniques for ventral or incisional hernia repair. Cochrane Database Syst Rev: CD007781
33.
Alfalah H, Philippe B, Ghazal F et al (2006) Intragastric balloon for preoperative weight reduction in candidates for laparoscopic gastric bypass with massive obesity. Obes Surg 16:147–150CrossRef
34.
Robinson SP, Hirtle M, Imbrie JZ et al (1998) The mechanics underlying laparoscopic intra-abdominal surgery for obese patients. J Laparoendosc Adv Surg Tech A 8:11–18CrossRef
35.
Carbonell AM, Warren JA, Prabhu AS et al (2018) Reducing length of stay using a robotic-assisted approach for retromuscular ventral hernia repair: a comparative analysis from the Americas Hernia Society Quality Collaborative. Ann Surg 267:210–217CrossRef
36.
Warren JA, Cobb WS, Ewing JA et al (2017) Standard laparoscopic versus robotic retromuscular ventral hernia repair. Surg Endosc 31:324–332CrossRef
Metadata
Title
Propensity score matching analysis of short-term outcomes in robotic ventral hernia repair for patients with a body mass index above and below 35 kg/m2
Authors
O. Y. Kudsi
F. Gokcal
K. Chang
Publication date
01-02-2021
Publisher
Springer Paris
Published in
Hernia / Issue 1/2021
Print ISSN: 1265-4906
Electronic ISSN: 1248-9204
DOI
https://doi.org/10.1007/s10029-019-02108-2

Other articles of this Issue 1/2021

Hernia 1/2021 Go to the issue

Original Article

Short-term outcomes of pediatric laparoscopic inguinal hernia repair in Korea based on Korean Health Insurance Big Data: 2011–2015

Original Article

Single-blind randomized clinical trial of transinguinal preperitoneal repair using self-expanding mesh patch vs. Lichtenstein repair for adult male patients with primary unilateral inguinal hernia

Original Article

Atrophic change of the abdominal rectus muscle significantly influences the onset of parastomal hernias beyond existing risk factors after end colostomy

Letter to the Editor

Would surgeons be definitively forbidden to restore the abdominal wall without using a mesh?

Original Article

Recurrent incisional hernia repair: surgical outcomes in correlation with body-mass index

Original Article

Improving surgical education in East Africa with a standardized hernia training program