Repair of ventral hernias in morbidly obese patients undergoing laparoscopic gastric bypass should not be deferred

Abstract

Biomaterial mesh (SIS) repair of ventral hernias concomitant with LRYGB resulted in the most favorable outcome albeit having short follow-up. Concomitant primary repair is associated with a high rate of recurrence. All incarcerated ventral hernias should be repaired concomitant with LRYGB, as deferment may result in small bowel obstruction.

Autologous Tissue Reconstruction of Ventral Hernias in Morbidly Obese Patients

“…This approach decreased the risk for complications, such as small-bowel incarceration and strangulation. 21 For example, Eid and colleagues 21 showed that, when the treatment of a ventral hernia was deferred at the time of a bariatric operation, small-bowel incarceration requiring emergent surgery occurred in approximately one-third of patients.…”

“…Evidence shows that recurrences and overall morbidity are optimal with laparoscopic repairs. [4][5][6]11,21 v The separation of components technique is particularly appropriate when infection is present or when concomitant bowel surgery is indicated. It is also the technique of choice for abdominal wall hernias that have recurred several times.…”

Outcome of laparoscopic ventral hernia repair in morbidly obese patients with a body mass index exceeding 35 kg/m2

“…The validity of this view has been questioned recently by new evidence demonstrating the efficacy and safety of LVHR for obese patients [2,3,5,8,10]. However, because most new evidence comes from small studies primarily consisting of patients with a BMI of 30 to 35 kg/m 2 , with morbidly obese patients representing only a small fraction (20-30%), definitive conclusions cannot be drawn [2,3,5,10].…”

“…Previous findings have shown that these hernias should be repaired using mesh concomitant with LGB. Deferment of repair, or simple suture repair often results in recurrence and postoperative small bowel obstruction [5]. The management however, of specific challenging clinical scenarios regarding 1) the type of ventral hernia (primary, incisional, recurrent), 2) the hernia size, 3) the BMI, 4) the clinical setting (elective, or emergency repair), 5) the concomitant bariatric surgery (LVHR alone, or combined with LGB) and 6) the type of mesh, in morbidly obese patients with ventral hernias and their effect on morbidity and recurrence rates has not been well investigated.…”

“…Previous findings have shown that these hernias should be repaired using mesh concomitant with LGB. Deferment of repair, or simple suture repair often results in recurrence and postoperative small bowel obstruction [5]. The management however, of specific challenging clinical scenarios regarding 1) the type of ventral hernia (primary, incisional, recurrent), 2) the hernia size, 3) the BMI, 4) the Presented at the 10th World Congress…”