Mohamed Dahman, MD, Katherine Graw, MD, Anna Dietrich-Covington, NP, Bruce Schirmer, MD, Peter Hallowell, MD. Department of Surgery, University of Virginia Health System, PO Box 800709, Charlottesville, VA 22908, USA
Introduction: Obesity has been associated with an increased incidence of hernia recurrence, wound infection, and possible worse outcomes after hernia repair. With more major abdominal surgical procedures being done, it’s estimated that around 20% may develop incisional hernia. The aim of this study is to evaluate outcomes of ventral hernia repair in the non obese vs. the obese
Methods: We did a retrospective study, looking at all the ventral hernia cases done from 2002 to 2009. We divided the patients into two groups; BMI<35 and BMI>35. We looked at demographics, ASA class, wound classification, operative time, operative technique, initial vs. recurrent hernias, morbidity, mortality.
Results: We had a total of 882 patients, n= 539 for BMI<35 vs. n=343 for BMI>35. Male/Female 285/254 for BMI<35 vs. 103/240 for BMI>35. Age 55.7+14 for BMI<35 vs. 50.1+12 for BMI>35. Average BMI of 28.1+4 for BMI<35 vs. BMI of 41.9+7.4 for BMI>35. Operative time was 1 hour 14 minutes for BMI<35 vs. 2 hours 3 minutes for BMI>35. With regards wound classification we had Clean 87.8%, Clean Contaminated 9.3%, Contaminated 1.3%, and Dirty 1.7% for BMI<35 vs. Clean 85.1%, Clean Contaminated 10.5%, Contaminated 1.2%, and Dirty 3.2% for BMI>35. ASA Class was mainly ASA 2 (55.8%), ASA 3 (34.3%) for BMI<35 vs. ASA 2 (55.1%), ASA 3 (40.2%) for BMI>35. We had 422 (78%) initial hernia repairs for BMI<35 vs. 224 (66%) for BMI>35. For the recurrent cases, we had 121 (22%) for BMI<35 vs. 116 (34%) for BMI>35. The recurrences rate was 9.6% for BMI<35 vs. 8.5% for BMI>35. With regards the approach 38% of cases done with laparoscopic approach and 62% done with open approach for BMI<35 vs. 34% with laparoscopic approach and 66% with open approach for BMI>35.We did note a mortality rate of 0.7% for BMI<35 vs. 0.9% for BMI>35. With regards Morbidities, we noted a rate of 11.9% for BMI<35 vs. 21% for BMI>35. Of these morbidities, we noted an incidence of 3.9% wound infection for BMI<35 vs. 7.9% for BMI>35. Seroma formation 3% for BMI<35 vs. 4.4% for BMI>35. Mesh infection 2% for BMI<35 vs. 1.7% for BMI>35. Bowel injury 0.9% for BMI<35 vs. 0% for BMI>35. These complications were not statistically significant (p<0.198).
Conclusions: According to the National Center for Health statistics, more than 100,000 ventral hernia repairs are performed annually in the USA. With the obesity epidemic on the rise, more data about outcomes and safety is crucial for providing the best care for our patients. Our study does demonstrate the feasibility and safety of ventral hernia repair in the obese population with comparable outcomes to the non obese.
Program Number: S072