Background: Deferring the repair of a ventral hernia found at the time of an antecolic laparoscopic gastric bypass (LGB) increases the incidence of bowel obstruction. However, the optimal repair technique has not been established. The use of prosthetic mesh has been shown to decrease the recurrence of ventral hernias compared to primary closure, yet the safety of non-biologic mesh in the setting of a clean-contaminated procedure is questionable.
Methods: A retrospective analysis of all patients who underwent a concomitant ventral hernia repair at the time of antecolic gastric bypass was undertaken. Ordered logistic regression was used to examine whether age, initial BMI, gender or hernia repair were associated with an increased length of stay (LOS; categorized by days).
Results: Of 282 consecutive LGB patients, fifteen (5%) were found to have significant ventral hernia defects. Of those fifteen, eight hernias were repaired primarily and seven underwent repair with prosthetic mesh. Three of the eight patients that underwent a primary hernia repair developed a small bowel obstruction at the previous repair site at four days, three months and one year after surgery. With an average follow-up for this group of 12 months (1-28 months) there were no mesh infections. There was only one complication in the mesh repair group. Three months after surgery, a laparoscopic lysis of painful adhesions was performed. The only measured predictor for increased LOS was hernia repair with mesh (Odds Ratio 9.2, p=0.002)
Conclusions: The use of prosthetic mesh at the time of LGB seems to be safe and more effective than primary repair.
Program Number: P018