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01-11-2013 | Letter To The Editor
Response to “Algorithm for Management of Ventral Hernia in Morbidly Obese Patients”
Published in: Obesity Surgery | Issue 11/2013
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We would like to thank the authors and editors for the opportunity to answer these very interesting comments. Our hernia algorithm is a suggestion on how to address the difficult issue of ventral hernias in the morbidly obese population. This is a work in progress and is still evolving. We appreciate all the great points raised in this communication:
1.
The authors stated that in their personal experience, the majority of hernias in bariatric patients happen to be periumbilical defects containing omentum. Many of these were asymptomatic and were incidental findings during bariatric procedures. Although this may be true in some patient populations, based on a study we published previously, the incidence of periumbilical hernias was about 10 %. These hernias do present a treatment dilemma and this has been addressed in our article. In addition, we also address the problem of ventral hernias in patients in whom the diagnosis has already been made [1].
2.
We do agree that the use of permanent intra-abdominal mesh is quite risky during bariatric procedures which have violated the gastrointestinal tract. Although there are several anecdotal reports in the literature of its successful use in this setting, this approach has not gained wide acceptance in the surgical community, as the risks are deemed too high.
3.
As for the placement of intraperitoneal meshes that may cause some degree of adhesion, it is important to differentiate between the different kinds of meshes used. Placement of prosthetic or biologic material may be necessary as primary repair may not be sufficient in some cases.