Objective: Obesity is a known risk factor for the development of incisional hernias. Despite the widespread use of prosthetic mesh, recurrence rates for open repair in obesity remain high. The magnitude of mechanical force exerted on the abdominal wall in obese individuals may contribute to a higher than expected recurrent incisional hernia rate. Laparoscopic ventral hernia repair (LVHR) has been shown to have a recurrence rate of 5% or less, however it is unclear whether obesity is a strong contributing factor.
Patients and methods: Review of a prospectively collected database was performed on all patients undergoing LVHR at a single tertiary care institution by one surgeon between August 1, 2004 to May 1, 2007. All individuals presenting for elective ventral hernia repair during this period were offered a laparoscopic repair. Non-absorbable prosthetic mesh was used for repair with mandatory suture and staple transfixion.
Results: A total of 27 consecutive patients underwent attempted laparoscopic ventral hernia repair. Average age of all patients was 57, with a male/female ratio of 8/19. The average weight of patients was 100kg. Average number of retention sutures used was 9 (4-24) and average mesh size was 400cm2 (72-2000). Mean operative time was 170 minutes and mean length of hospital stay was 3 days. Recurrence was noted in 5(18%) individuals. Weight of patients with recurrence (82kg, 92kg, 102kg, 110kg, 112kg). Previous open hernia repair had been performed in 6 patients (23%). Of the recurrences 2 had previous hernia repair (40%). Mean length of follow-up was 20 weeks. There were no mesh infections and no peri-operative deaths. Conversion occurred in 1 patient following small bowel injury during laparoscopic dissection. Open repair of the bowel injury was performed and primary non-mesh hernia repair completed without subsequent complication.
Conclusion: In this series obesity is associated with a high recurrence of incisional hernias after laparoscopic repair. Emphasis may need to be placed on modificiation of the laparoscopic technique to include wider overlap of fascial defects with more trans-fascial sutures to attempt to reduce this occurrence.
Program Number: P352