Laparoscopic Ventral Hernia Repair in Bariatric Patients: the Role of Defect Size and Deferred Repair
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Laparoscopic Ventral Hernia Repair in Bariatric Patients: the Role of Defect Size and Deferred Repair Stefano Olmi 1 & Matteo Uccelli 1 & Giovanni Carlo Cesana 1 & Francesca Ciccarese 1 & Alberto Oldani 1 & Riccardo Giorgi 1 & Stefano Maria De Carli 1 & Roberta Villa 1 & Adelinda Angela Giulia Zanoni 1 & Ayman Ismail 1 Received: 24 February 2020 / Revised: 22 May 2020 / Accepted: 28 May 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose To analyze the safety of laparoscopic ventral hernia delayed repair in bariatric patients with a composite mesh. Materials and Methods This retrospective single-center observational trial analyzed all bariatric/obese patients with concomitant ventral hernia who underwent laparoscopic abdominal hernia repair before bariatric surgery (group A) and laparoscopic delayed repair after weight loss obtained by the bariatric procedure (group B). Results Group A (30 patients) had a mean BMI of 37.8 ± 5.7 kg/m2 (range: 34.0–74.2 kg/m2); group B (170 patients) had a mean BMI of 24.6 ± 4.5 kg/m2 (range 19.0–29.8 kg/m2) (p < 0.05). Mean operative time: group A, 51.7 ± 26.6 min (range 30–120); group B 38.9 ± 21.5 min (range 25–110) (p < 0.05). Average length of stay: group A, 2.0 ± 2.7 days (range 1–5) versus group B, 2.8 ± 1.9 days (range 1–4) (p > 0.5). Recurrent hernia group A 1/30 (3.3%) versus recurrent hernia group B 4/170 (2.3%) (p > 0.5). Bulging: group A, 3/30 (10.0%) versus group B, 0/170 (0%) (p = 0.23). Conclusion The present study demonstrates the safety of performing LDR in patient candidates for bariatric surgery in cases of a large abdominal hernia (W2–W3) with a low risk of incarceration or an asymptomatic abdominal hernia. In the case of a small abdominal hernia (W1) or strongly symptomatic abdominal hernia, repair before bariatric surgery, along with subsequent bariatric surgery and any revision of the abdominal wall surgery with weight loss, is preferable. Keywords Laparoscopic ventral hernia repair . Bariatric surgery . Sleeve gastrectomy . Composite mesh . IPOM
Introduction The incidence of incisional hernia as a complication of abdominal surgery is variously described in the literature [1, 2]: in a 2014 systematic review, over an average observational period of 23.7 months, the average rate of abdominal hernias
was estimated to be 12.8% [1]. Infection of the incision will increase the rate of hernia up to 23% [3–5]. In 2009, the European Hernia Society (EHS) developed a classification for incisional and ventral hernias [6]. In this classification, the incisional hernias are distinguished by location (median and lateral) and by size (W1 < 4 cm; W2 4–10 cm; W3 >
* Matteo Uccelli [email protected]
Stefano Maria De Carli [email protected]
Stefano Olmi [email protected]
Roberta Villa [email protected]
Giovanni Carlo Cesana [email protected]
Adelinda Angela Giulia Zanoni [email protected]
Francesca Ciccarese [email protected] Alberto Oldani [email protected]
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