Selective Placement of Synthetic Mesh During Clean-Contaminated Laparoscopic Bariatric Procedures is Safe

Edward J Hannoush, MD, Kurt E Roberts, MD, Robert L Bell, MD, Andrew J Duffy, MD. Yale University. Yale School of Medicine..

Introduction:
Simultaneous laparoscopic repair of abdominal ventral hernia with intraperitoneal synthetic mesh in patients undergoing laparoscopic-stapled bariatric surgery is generally considered ill advised due to the assumed higher risk of infectious complications. However evidence interrogating this issue is lacking. We studied hernia repair outcomes and postoperative mesh infectious complications in patients undergoing concurrent laparoscopic clean-contaminated bariatric surgery procedures and abdominal wall hernia repair.

Methods:
Retrospective review of 13 consecutively sampled patients undergoing concurrent clean-contaminated bariatric surgery and hernia repair between January 2009 and December 2012. Average age was 52±9.5, body mass index 45.7±5.1 and male-to-female ratio 1:2.2. All patients met eligibility criteria for bariatric surgery. Decision and technique of concurrent hernia repair was made preoperatively after discussion with the patient based on the presumed risk of short-term hernia morbidity. 10 patients undergoing Laparoscopic Roux-en-Y Gastric Bypass and three undergoing Laparoscopic Sleeve Gastrectomy had 12 (nine incional and three primary ventral) and three (two incisional and one primary ventral) hernias repaired respectively. All hernias were repaired using Parietex™ Composite (PCO) mesh except in two patients that underwent primary repair. Collectively, 13 meshes were used in 11 patients ranging in size from 9cm round to 20cm x 15cm

RESULTS
Average follow up was 1.43 years (range: 6 months to 3 years). There were no mesh infections. Five patients had hernia-related complications. One patient in whom mesh was not used had a hernia recurrence, one patient developed a chronic sterile seroma, there were two mesh eventrations after substantial weight loss and one patient developed significant diastasis of the rectus muscle without hernia recurrence.

CONCLUSIONS
In selected patients, concurrent synthetic mesh-repair of abdominal wall hernia and laparoscopic bariatric surgery appears to be safe and feasible without increase in mesh infections. Weight loss induced-changes in the abdominal wall might change the ultimate cosmetic appearance after hernia repair.