Laparoscopic treatment of incisional and primary ventral hernia in morbidly obese patients with a BMI over 35

Marx, Ludovic; Raharimanantsoa, M; Mandalà, Stefano; D’Urso, Antonio; Vix, Michel; Mutter, Didier

doi:10.1007/s00464-014-3607-6

Cited by 18 publications

(8 citation statements)

References 13 publications

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“…Several studies have demonstrated the advantages of LVHR, even more so when addressed at the time of laparoscopic WLS, such as a roux-en-Ygastric bypass (RYGB). [11][12][13] These studies report a wide range of recurrence rates. Patients with a mean BMI of over 40 kg/m 2 who undergo laparoscopic repair had a recurrence rate ranging from 4% to 18%.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Open Retro-Rectus Hernia Repair With Mesh in Obesity Class III

Martı́nez

Dove

Blansfield

et al. 2020

The American Surgeon™

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Background Abdominal wall hernias continue to be one of the most common general surgery pathologies. Patients with an elevated body mass index (BMI) are routinely counseled about weight loss before elective repair. However, a definitive BMI “cutoff” has not been established. Here, we report our experience with open retro-rectus hernia repair (ORRHR) with mesh in patients with a BMI over 40 kg/m2, and we attempt to determine if a BMI “cutoff” can be established. Methods Data from patients undergoing ORRHR with mesh at Geisinger Medical Center from January 1, 2014, to December 31, 2018, were collected and retrospectively analyzed. Results Cohorts were composed of 2 groups, BMI ≥ 40 kg/m2 (n = 117) and BMI < 40 kg/m2 (n = 90). All patients underwent an elective ORRHR with mesh. Operative time increased significantly as the patient’s BMI increased ( P ≤ .01). Patients in the higher BMI group had a significantly higher rate of surgical site infections (SSIs) (8.55% vs. 1.1%, P = .018). Higher BMI did not translate to a higher recurrence rate. Conclusions Patients undergoing ORRHR with mesh who had a BMI over 40 kg/m2 had an increased risk of SSI and longer operative time, possibly suggesting a potential association other than SSI and BMI. More studies are needed to determine if BMI is indeed correlated with hernia recurrence and if BMI should influence the decision to undergo repair.

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Section: Discussionmentioning

confidence: 99%

Outcomes of Open Retro-Rectus Hernia Repair With Mesh in Obesity Class III

Martı́nez

Dove

Blansfield

et al. 2020

The American Surgeon™

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“…Laparoscopic repair of large parietal wall defects is a wellaccepted and safe option for class II and class III obesity patients. 2 There are many parameters adherent to hernias (size, location, primary versus recurrent, symptomatic versus asymptomatic, reduced versus nonreduced) that may affect the decision to perform a ventral hernia repair during a bariatric procedure. In a 2017 large cohort study there was increased 30 day morbidity, 3 although specific hernia characteristics were not assesed.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic and robotic ventral hernia repair in obese and morbidly obese patients: initial experience and review of the literature

Hirides¹,

N²,

Galanopoulou³

et al. 2018

AOWMC

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Introduction: Laparoscopic repair of large parietal wall defects is a well-accepted and safe option for class II and class III obesity patients. Apart from cardiorespiratory and anesthesiological parameters, main concerns with such patients include the relatively higher risks of wound infection and recurrencies as well as postoperative hemorrhage and port-site hernias. However, advantages over classic-open repairs are well demarcated in the literature. Robotic surgery is a newcomer in the field of hernia surgery with unknown superiority towards older, established approaches. Material: Nine hernia repairs were performed in eight patients with BMIs >35, aged 31-74 years. Their hernias were epigastric (n=2), umbilical (n=3) and incisional (n=4). All patients underwent full preoperative workup, including history, physical examination, evaluation from cardiologist, anesthesiologist, as well as pneumologist and gave consent for the procedures as well as for this paper. Large incisional hernias were treated with self-expanding or self-adhering mesh. A robotic approach was used in five cases. One patient, who underwent a sleeve gastrectomy, had his umbilical hernia repaired during the same procedure. Results: All eight patients followed an uncomplicated course. Patients were discharged as soon as bowel function returned (postoperative days 2-4). Seromas developed in four patients and were treated by aspiration of the collection. In our largest patient (BMI=47) an infection of the camera port site was noted on postoperative day 7, and was drained succesfully on an outpatient basis. Conclusion: Initial access and induction of pneumoperitoneum has been the most challening phase of all hernia repairs in obese patients. Robotics seems to facilitate extensive adhesiolysis during incisional hernia repairs. Self-expanding meshes aid fast and correct placement of the mesh in large defects, decreasing technical challenges.

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“…[40] Laparoscopic AWR seems also to be associated with fewer surgical site infections and reoperations [8] and with a shorter hospital stay. [9] Nevertheless, in morbidly obese patients, a staged or concomitant bariatric surgery has been shown to be safe and feasible.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Body Mass Index on Abdominal Wall Reconstruction Outcomes: A Comparative Study

Giordano

Garvey

Baumann

et al. 2017

Plastic &Amp; Reconstructive Surgery

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Background Obesity and higher body mass index (BMI) may be associated with higher rates of wound healing complications and hernia recurrence rates following complex abdominal wall reconstruction (AWR). We hypothesized that higher BMI’s result in higher rates of postoperative wound healing complications but similar rates of hernia recurrence in AWR patients. Methods We included 511 consecutive patients who underwent AWR with underlay mesh. Patients were divided into three groups on the basis of preoperative BMI: <30 kg/m2 (non-obese), 30–34.9 kg/m2 (class I obesity) and ≥35 kg/m2 (class II/III obesity). We compared postoperative outcomes among these three groups. Results Class I and class II/III obesity patients had higher surgical site occurrence rates than non-obese patients (26.4% vs. 14.9%; p=0.006 and 36.8% vs. 14.9%; p<0.001, respectively) and higher overall complication rates (37.9% vs. 24.7%; p=0.007 and 43.4% vs. 24.7%; p<0.001, respectively). Similarly, obese patients had significantly higher skin dehiscence (19.3% vs 7.2%; p<0.001 and 26.5% vs 7.2%; p<0.001, respectively) and fat necrosis rates (10.0% vs 2.1%; p=0.001 and 11.8% vs 2.1%; p<0.001, respectively) than non-obese patients. Obesity class II/III patients had higher infection and seroma rates than non-obese patients (9.6% vs 4.3%; p=0.041 and 8.1% vs 2.1%; p=0.006, respectively). However, class I and class II/III obesity patients experienced hernia recurrence rates (11.4% vs. 7.7%; p=0.204 and 10.3% vs. 7.7%; p=0.381, respectively) and freedom from hernia recurrence (overall log-rank p=0.41) similar to non-obese patients. Conclusions Hernia recurrence rates do not appear to be affected by obesity on long-term follow-up in AWR.

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Laparoscopic treatment of incisional and primary ventral hernia in morbidly obese patients with a BMI over 35

Cited by 18 publications

References 13 publications

Outcomes of Open Retro-Rectus Hernia Repair With Mesh in Obesity Class III

Outcomes of Open Retro-Rectus Hernia Repair With Mesh in Obesity Class III

Laparoscopic and robotic ventral hernia repair in obese and morbidly obese patients: initial experience and review of the literature

The Impact of Body Mass Index on Abdominal Wall Reconstruction Outcomes: A Comparative Study

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