Gautam Sharma, MD, Mena Boules, MD, Suriya Punchai, MD, Dvir Froylich, MD, Stacy Brethauer, MD, Phillip Schauer, MD, Kevin El-Hayek, MD, John Rodriguez, MD, Matthew Kroh, MD. Cleveland Clinic Foundation
Introduction: Currently there is no consensus on management of ventral hernias encountered during bariatric surgery. This study aims to evaluate the incidence and outcomes of concomitant ventral hernia repair (VHR) during bariatric surgery (BS) at our institution.
Methods: Patients who had concomitant VHR repair during bariatric surgery from 2004 to 2015 were identified. Data collected included baseline demographics, co-morbidities, perioperative parameters, surgical approach, and postoperative outcomes. Parameters were analyzed using Wilcoxon rank-sum test for continuous variables and Chi-square test for categorical variables.
Results: A total of 103 (1.0% of all bariatric cases) patients underwent concomitant VHR during the study period. Sixty-five (63%) patients were female; mean age was 53.5 ± 9.8 years and mean BMI was 49.7 ± 10.0 kg/m2. Baseline comorbidities included: hypertension (n=85, 83%), type 2 diabetes (n=68, 66%), hyperlipidemia (n=64, 62%), obstructive sleep apnea (n=56, 54%) and reflux disease (n=33, 32%). 23/103 (22.3%) had a prior VHR. 61 (59%) patients underwent Roux-en-Y gastric bypass (RYGB), 38 (37%) sleeve gastrectomy and 4 patients underwent adjustable gastric banding. 69/103 (67 %) patients had a previous abdominal surgery. Of the concomitant VHR, 90 (87.4%) were completed Laparoscopically, 10 (9.7 %) patients were converted to open surgery and 3 (3.0%) patients underwent primary open procedures. Technique included primary suture closure in 68 (66.0%), and mesh repair in 35. Of the 35 mesh implants, 22 were biologic, 7 were synthetic, and 6 synthetic absorbable.
Mean operative duration and estimated blood loss was 217 ± 66.5 minutes and 94 ± 70.4 mL respectively. Early post-operative complications (<30 days) were reported in 12 (11.6%) patients, with superficial wound infection (n=8),, bowel obstruction (n=2), mesh infection (n=1), marginal ulcer (n=1), DVT (n=1), pneumonia (n=1), enterotomy (n=1)
Hernia recurrence was reported in 2 patients (2%) in the early post-op period and in 12 patients (12%) as a late (>30 days) complication, at a mean duration of 205 ± 169.4 days from the primary procedure. Recurrent VHR was performed in 10/14 patients. At 12 months follow-up, mean BMI and % excess weight loss (%EWL) were 36.5 ± 9.4 kg/m2, and 59.4 ± 26.1% respectively.
Conclusion: Ventral hernia is a common finding in patients undergoing bariatric surgery. Both primary suture repair and mesh repair result in acceptable results, both in terms of recurrence and peri-operative complications.