Staged complex abdominal wall hernia repair in morbidly obese patients

Abstract

Purpose

The repair of complex abdominal wall hernias in morbidly obese patients is often associated with a higher risk of complications and hernia recurrences. Improvement in obesity and its associated metabolic complications are hypothesized to improve hernia repair outcomes. This study analyzes outcomes from morbidly obese patients who underwent bariatric surgery with staged complex abdominal wall reconstruction at Creighton University Medical Center (CUMC).

Methods

This retrospective study included morbidly obese patients with complex abdominal wall hernia, who underwent bariatric surgery with staged abdominal wall reconstruction. Data points collected included patient demographics, obesity-related co-morbidities, pre-operative BMI, EBMIL at 12 months, hernia characteristics, postoperative complications, BMI at time of hernia repair, and hernia recurrence.

Results

Twelve patients with an average BMI of 48 and complex abdominal wall hernias (mean width 14.0 cm) met inclusion criteria. Seven patients (58%) had significant loss of domain. Bariatric procedures included six laparoscopic sleeve gastrectomies (LSG), three laparoscopic Roux-en-Y gastric bypasses (LRNYGB), and three revisional procedures (2 vertical band gastroplasties to LRNYGB and 1 LRNYGB revision). At 12-month follow-up, the mean excess BMI loss (EBMIL) was 64.6%. The average time to staged complex abdominal wall reconstruction was 22.3 months. Two non-elective hernia repairs were performed due to one incarceration and one strangulation. There were no recurrences after an average follow-up of 21.9 months.

Conclusions

In this study, staged mesh repair of complex abdominal wall hernias after bariatric surgery in morbidly obese patients was associated with acceptable morbidity and no hernia recurrences at approximately 1.5 year follow-up.

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Data availability

The authors affirm that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

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Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

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Correspondence to K. Nandipati.

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Conflicts of interest

Authors Alexander D Schroeder, Turna Mukherjee, Nara Tashjian, Margaret Siu, Robert Fitzgibbons Jr., and Kalyana Nandipati declare that they have no conflict of interest.

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Ethics approval

This research study was conducted retrospectively from data obtained for clinical purposes. We consulted extensively with the IRB of Creighton University, Omaha, Nebraska, who determined that our study did not need ethical approval and was granted exempt status (IRB ID 1034892-6). An IRB official waiver of ethical approval was granted from the IRB of Creighton University.

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Schroeder, A.D., Mukherjee, T., Tashjian, N. et al. Staged complex abdominal wall hernia repair in morbidly obese patients. Hernia (2020). https://doi.org/10.1007/s10029-020-02253-z

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Keywords

  • Complex hernia
  • Staged hernia repair
  • Morbid obesity
  • Bariatric surgery