Hernia Surgery pp 393-399 | Cite as

Management of Ventral Hernia in the Morbidly Obese Patient

  • Jeffrey A. BlatnikEmail author
  • Ajita S. Prabhu


Morbidly obese patients with ventral hernias represent a different clinical challenge and level of complexity when compared with ventral hernia patients of normal weight. While obesity has not been identified as an independent risk factor for hernia recurrence, it still contributes to perioperative morbidity and should be considered as a significant factor in patient selection and operative plans. Here we present some of the variables which must be taken into consideration when selecting operative candidates and planning hernia repairs for these patients. We also provide a suggested algorithm to the approach of these patients.


Morbid obesity Obesity and ventral hernia recurrence Approach to obese patient with ventral hernia 


  1. 1.
    Poulose BK, Shelton J, Phillips S, Moore D, Nealon W, Penson D, et al. Epidemiology and cost of ventral hernia repair: making the case for hernia research. Hernia. 2012;16(2):179–83.CrossRefPubMedGoogle Scholar
  2. 2.
    Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011–2012. JAMA. 2014;311(8):806–14.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Sugerman HJ, Kellum JM, Reines HD, Demaria EJ, Newsome HH, Lowry JW. Greater risk of incisional hernia with morbidly obese than steroid-dependent patients and low recurrence with prefascial polypropylene mesh. Am J Surg. 1995;171:80–4.CrossRefGoogle Scholar
  4. 4.
    Breuing K, Butler CE, Ferzoco S, Franz M, Hultman CS, Kilbridge JF, et al. Incisional ventral hernias: review of the literature and recommendations regarding the grading and technique of repair. Surgery. 2010;148(3):544–58.CrossRefPubMedGoogle Scholar
  5. 5.
    Heniford BT, Park A, Ramshaw BJ, Voeller G. Laparoscopic repair of ventral hernias: nine years’ experience with 850 consecutive hernias. Ann Surg. 2003;238(3):391–9. discussion 399–400.PubMedPubMedCentralGoogle Scholar
  6. 6.
    Sauerland S, Korenkov M, Kleinen T, Arndt M, Paul A. Obesity is a risk factor for recurrence after incisional hernia repair. Hernia. 2004;8(1):42–6.CrossRefPubMedGoogle Scholar
  7. 7.
    Cobb WS, Burns JM, Kercher KW, Matthews BD, James Norton H, Todd Heniford B. Normal intraabdominal pressure in healthy adults. J Surg Res. 2005;129(2):231–5.CrossRefPubMedGoogle Scholar
  8. 8.
    Pessaux P, Lermite E, Blezel E, Msika S, Hay J-M, Flamant Y, et al. Predictive risk score for infection after inguinal hernia repair. Am J Surg. 2006;192(2):165–71.CrossRefPubMedGoogle Scholar
  9. 9.
    Eknoyan G. Adolphe Quetelet (1796–1874)—the average man and indices of obesity. Nephrol Dial Transplant. 2008;23(1):47–51.CrossRefPubMedGoogle Scholar
  10. 10.
    Keys A, Fidanza F, Karvonen MJ, Kimura N, Taylor HL. Indices of relative weight and obesity. J Chronic Dis. 1972;25(6):329–43.CrossRefPubMedGoogle Scholar
  11. 11.
    Mathews EM, Wagner DR. Prevalence of overweight and obesity in collegiate American football players, by position. J Am Coll Health. 2008;57:33–8.CrossRefPubMedGoogle Scholar
  12. 12.
    Eid GM, Wikiel KJ, Entabi F, Saleem M. Ventral hernias in morbidly obese patients: a suggested algorithm for operative repair. Obes Surg. 2013;23:703–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Sanni A, Perez S, Medbery R, Urrego HD, McCready C, Toro JP, et al. Postoperative complications in bariatric surgery using age and BMI stratification: a study using ACS-NSQIP data. Surg Endosc. 2014;28(12):3302–9.CrossRefPubMedGoogle Scholar
  14. 14.
    Cozacov Y, Szomstein S, Safdie FM, Lo Menzo E, Rosenthal R. Is the use of prosthetic mesh recommended in severely obese patients undergoing concomitant abdominal wall hernia repair and sleeve gastrectomy? J Am Coll Surg. 2014;218(3):358–62.CrossRefPubMedGoogle Scholar
  15. 15.
    Praveen Raj P, Senthilnathan P, Kumaravel R, Rajpandian S, Rajan PS, Anand Vijay N, et al. Concomitant laparoscopic ventral hernia mesh repair and bariatric surgery: a retrospective study from a tertiary care center. Obes Surg. 2012;22(5):685–9.CrossRefPubMedGoogle Scholar
  16. 16.
    Spaniolas K, Kasten KR, Mozer AB, Sippey ME, Chapman WHH, Pories WJ, et al. Synchronous ventral hernia repair in patients undergoing bariatric surgery. Obes Surg. 2015;25(10):1864–8.CrossRefPubMedGoogle Scholar
  17. 17.
    Raziel A, Sakran N, Szold A, Goitein D. Concomitant bariatric and ventral/incisional hernia surgery in morbidly obese patients. Surg Endosc. 2013;28(4):1209–12.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of Surgery, Section of Minimally Invasive SurgeryWashington University School of MedicineSt. LouisUSA
  2. 2.Department of SurgeryUniversity Hospitals Case Medical CenterClevelandUSA

Personalised recommendations