Laparoscopic ventral hernia repair in patients with obesity: should we be scared of body mass index?

Abstract

Background Obesity is a risk factor for ventral hernia development and affects up to 60% of patients undergoing ventral hernia repair. It is also associated with a higher rate of surgical site occurrences and an increased risk of recurrence after ventral hernia repair, but data is lacking on the differences between obesity classes. Methods Between 2008 and 2018, 322 patients with obesity underwent laparoscopic ventral hernia repair in our department: class I n = 231 (72%), II n = 55 (17%), III n = 36 (11%). We compared short and long-term outcomes between the three classes. Results Patients with class III obesity had a longer median length of hospital stay compared to I and II (5 days versus 4 days in the other groups, p = 0.0006), but without differences in postoperative complications or surgical site occurrences. After a median follow up of 49 months, there were no significant differences in the incidence of seroma, recurrence, chronic pain, pseudorecurrence and port-site hernia. At multivariate analysis, risk factors for recurrence were presence of a lateral defect and previous hernia repair; risk factors for seroma were immunosuppression, defect > 15 cm and more than one previous hernia repair; the only risk factor for postoperative complications was chronic obstructive pulmonary disease. Conclusion Class III obesity is associated with longer length of hospital stay after laparoscopic ventral hernia repair, but without differences in postoperative complications and long-term outcomes compared with class I and class II obesity.

Body Mass Index Effect on Minimally Invasive Ventral Hernia Repair: A Systematic Review and Meta-analysis

“…After removing duplicates and unrelated studies, 26 studies were fully assessed for eligibility. After excluding studies that included open cases and did not compare patients with different BMIs, 11 studies with a total of 3199 patients were included 4,9,12–20 . Studies characteristics are reported in Table 1.…”

“…The majority of studies included only laparoscopic intraperitoneal onlay mesh (IPOM) without defect closure, whereas 2 included only laparoscopic or robotic retromuscular repairs and 2 included robotic IPOM+, preperitoneal and retromuscular repairs. Five studies compared patients with BMI >40 kg/m 2 and <40 kg/m 2 , 4,12–15 5 studies compared patients with BMI >35 kg/m 2 and <35 kg/m 2 , 9,14,16–18 and 4 studies compared patients with BMI >30 kg/m 2 and <30 kg/m 2 13,15,19,20 . Two studies had mean/median follow-up between 6 and 12 months, 5 between 1 and 2 years, and 4 >2 years.…”

“…26 MIS techniques might minimize complications in obese patients and several studies compared different BMI ranges in patients undergoing MIS VHR. 4,9,[12][13][14][15][16][17][18][19][20] In one of the most extensive case series, including 134 patients with BMI > 40 kg/m 2 and 767 patients with BMI <40 kg/m 2 undergoing laparoscopic IPOM, Tsereteli et al 4 found a significant difference in hernia recurrence (8.3% in morbidly obese and 2.9% in nonmorbidly obese), but no difference in the rate of overall complications. Maspero et al 14 studied 322 obese patients undergoing laparoscopic IPOM and found no significant difference in complications or hernia recurrence rates comparing patients with class I, II, and III obesity.…”

“…MIS techniques might minimize complications in obese patients and several studies compared different BMI ranges in patients undergoing MIS VHR 4,9,12–20 . In one of the most extensive case series, including 134 patients with BMI >40 kg/m 2 and 767 patients with BMI <40 kg/m 2 undergoing laparoscopic IPOM, Tsereteli et al 4 found a significant difference in hernia recurrence (8.3% in morbidly obese and 2.9% in nonmorbidly obese), but no difference in the rate of overall complications.…”

“…After excluding studies that included open cases and did not compare patients with different BMIs, 11 studies with a total of 3199 patients were included. 4,9,[12][13][14][15][16][17][18][19][20] Studies characteristics are reported in Table 1. All studies included were retrospective or retrospective reviews of prospectively collected data.…”