Incisional/Ventral Hernia Repairs in the Morbidly Obese: New Technique for an Old Problem

Francis Baccay, MD1, Ki Won Kim, MD1, Colin Dunn2, Jai P Singh3, Irene J Lo4. 1Montefiore Medical Center/Albert Einstein College of Medicine, 2Albert Einstein College of Medicine, 3SUNY Upstate Medical Center, 4West Coast Surgical Associates, Inc

Introduction: The occurrence rate of incisional/ventral hernias after laparotomies has been reported to be as high as 11%1. Every surgery has risks and complications; however, patients with higher body mass index (BMI) are at higher risk of complications.  Morbid obesity is a risk factor for ventral hernias, both as a feature of their occurrence and as a factor contributing to recurrence after repair.  Using multiple symmetrically placed suture lines with direct mid-line fascial graft reinforcement, we report our experience with this technique.

Methods and Procedures: A total of 90 consecutive patients with incisional/ventral hernias were repaired.  Patients without medical clearance as well as patients with umbilical hernias were excluded. All patients, including those with higher BMI, underwent repair without regard to pre-operative weight loss. All hernias were repaired using open bilateral component separation and biologic grafts placed in a retro-rectus position, either pre-peritoneal or intra-peritoneal. 

Results: There were no recurrences, re-admissions or mortalities. Mean follow-up was 38.4 months (7 – 66 months), mean age was 56.7 years old (37 – 84 years old), and mean BMI was 42.6 kg/m2 (30.5 – 58.6 kg/m2). Mean hernia size was 390 cm2 (248 – 610 cm2) and mean length of stay was 4.68 days (2 – 8 days). Wound infection rate was 3.3% (3/90). Post-operative mean weight loss was noted to be 15.6% (11.3% to 17.5%).

Conclusions: With the rise in prevalence of obesity, most general surgeons will have to face the problem of the obese patient with an abdominal wall defect. Treatment of these bariatric patients raises unique challenges, and at this time, there is still no consensus on the best treatment option.  In this series, we demonstrate excellent outcomes in safety and efficacy using this technique of multiple symmetrically placed suture lines with direct mid-line fascial graft reinforcement.2 Larger prospective trials comparing outcome with other laparoscopic or open techniques are warranted.

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