Takeshi Naitoh, MD, N Tanaka, MD, H Imoto, MD, T Tsuchiya, MD, M Nagao, MD, H Musha, MD, K Watanabe, MD, T Aoki, MD, K Kudo, MD, T Abe, MD, S Ohnuma, MD, F Motoi, MD, M Unno, MD. Department of Surgery, Tohoku Univ Graduate School of Med
Backgrounds: Morbid obese patients often develop an umbilical hernia. Laparoscopic approach has become a popular option for the treatment of ventral hernia. The intraperitoneal onlay mesh (IPOM) technique is a standard technique and its outcome is quite acceptable. However, the IPOM requires to use an artificial mesh and contamination of the mesh must be avoided. Therefore, when performing the gastrointestinal surgery, the use of the mesh should be discussed carefully. We have experienced 40 cases of bariatric surgery and two of those had a large umbilical hernia. We report how we manage the umbilical hernia of these cases.
[Case 1] Forty-eight year-old female who was scheduled to undergo the Roux-en Y gastric bypass (RYGB) had an umbilical hernia. A CT-scan revealed the omentum was packed in the hernia sac. At the beginning, the incarcerated omentum was repositioned but the hernia orifice was not repaired because we were afraid of mesh contamination. The hernia repair were planned to perform after body weight reduction was achieved. On the next day, the patient complained the abdominal pain with a bulging of the umbilicus that was diagnosed as an incarceration of the small bowel. The patient underwent the emergency laparoscopic ventral hernia repair using ePTFE patch.
[Case 2] Forty-seven year-old female had an umbilical hernia and underwent Sleeve gastrectomy. The orifice was at the umbilicus but the sac was expanded toward head. Then we inserted the first trocar from the left upper quadrant. Based on our previous experience, if the packed omentum would not affect the procedure, we would leave the omentum as it was packed. However, since the packed omentum affected the trocar insertion, we took out the omentum from the hernia. After the sleeve gastrectomy, we close the orifice with 2 unabsorbable suture without using mesh. The patient was discharged uneventfully and the IPOM might be necessary after weight reduction is achieved.
Discussion: The umbilical hernia is a common co-morbidity of obese patients. In case that the hernia content is the omentum, the reposition of the omentum without hernia repair might be the cause of the later incarceration of the intestine. However, the use of the mesh might be the cause of the mesh contamination.
Conclusion: The treatment of the umbilical hernia of the patient undergoing the bariatric surgery is the worrisome issue. We should be very careful to decide how to treat the umbilical hernia when doing the bariatric surgery.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 78783
Program Number: P502
Presentation Session: Poster (Non CME)
Presentation Type: Poster
