Ainsley B Freshour, MD, Sunil Sharma, MD
University of Florida – Jacksonville
Introduction: The finding of a ventral hernia in a morbidly obese patient is not uncommon. The right approach in managing such patients is always debatable. Typically, weight loss surgery is performed first, and after adequate weight loss definitive repair of the hernia is performed. Combining the two operations subjects a patient to the risk of mesh infection as the surgery is then considered clean contaminated. Alternatively, early repair of the hernia has a higher risk of recurrence. Here, we propose a method for definitive hernia repair coupled with a weight-loss operation that is clean, to both decrease the risk of recurrence and improve the health of our patient.
Method: We propose the combination of two operations, definitive repair of a hernia and gastric imbrication, in symptomatic hernia patients. With this approach, since there is no violation of an enteric lumen, the abdomen remains sterile enabling us to use permanent mesh for definitive repair of hernia. Subsequent weight loss prevents the recurrence while having the added benefit of resolving co-morbidities associated with morbid obesity. Laparoscopic reduction of hernia content is performed first. Using same ports, the greater curvature is mobilized. Two layer plication of the stomach is then performed. Endoscopy is utilized to check for leak, bleeding, and tube size. Finally repair of the hernia is performed using synthetic mesh.
Result: An 18 month follow up shows an intact hernia repair with a drop in BMI to 25 and resolution of most of the co-morbidities.
Conclusion: While more studies are needed to support this concept, the combination technique seems reasonable and intuitive. This provides our patients with the best of both worlds: weight loss with resolution of co-morbidities and a durable repair of the ventral hernia.
Session: Podium Presentation
Program Number: V031
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