Advertisement

Incisional Hernia in Obese Patients

  • Luigi Angrisani
  • Michele Lorenzo
  • Pier Paolo Cutolo
Part of the Updates in Surgery book series (UPDATESSURG)

Abstract

Incisional hernia is one of the most frequent complications of abdominal surgery [1,2]. Different aetiologies have been hypothesized, including patient factors such as older age, cancer, diabetes, malnutrition, chronic steroid therapy, and wound factors such as lower midline incision, re-incision and wound infections [3,4]. In abdominal surgery, by far, obesity has long been recognised as one of the most relevant conditions predisposing to the development of this very frequent complication of laparotomic surgery [4, 5, 6]. However, the introduction of laparoscopy in abdominal surgery for cholecystectomy and hysterectomy has produced a remarkable decrease in the incidence of incisional hernias. The wide diffusion of laparoscopy for the surgical treatment of obesity has also sharply reduced the dimension of this problem among bariatric surgical patients [7,8]. Nevertheless a consistent number of obese patients with incisional and/or recurrent incisional hernia are often referred to bariatric surgery centres because of the importance of extensive surgical and anaesthesiological experience in treating patients with this complex condition. By definition, in fact, obese patients are classified by the American Society of Anaesthesiology (ASA) as type III–IV, as respiratory insufficiency is obviously aggravated by the incisional hernia and potentially by its repair.

Keywords

Bariatric Surgery Obese Patient Hernia Repair Incisional Hernia Laparoscopic Adjustable Gastric Banding 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Pondos YD, Jimenez JC, Wilson SE et al (2003) Complications after laparoscopic gastric bypass. A review of 3464 cases. Arch Surg 138:957–961CrossRefGoogle Scholar
  2. 2.
    Chevrel JP, Rath AM. (2000) Classification of incisional hernias of the abdominal wall. Hernia 4:7–11CrossRefGoogle Scholar
  3. 3.
    Condon RE (1995) Incisional hernia. In: Nyhus LH, Condon RE Eds, Hernia, (4th ed), Lippincott, Philadelphia, pp 319–328Google Scholar
  4. 4.
    Sugerman HJ, Kellum JM, Reines HD et al (1996) Greater risk of incisional hernia with morbidly obese than steroid-dependent patients and low recurrence with prefascial polypropylene mesh. Am J Surg 171:80–84PubMedCrossRefGoogle Scholar
  5. 5.
    Cleveland RD, Zitsch RP, Laws HL (1989) Incisional hernia in morbidly obese patients. Am Surg 55:61–63PubMedGoogle Scholar
  6. 6.
    Hesselink VJ, Luijendijk RW, de Wilt JHW et al (1993) An evaluation of risk factors in incisional hernia recurrence. Surg Gynecol Obstet 176:228–234PubMedGoogle Scholar
  7. 7.
    Herron DM (2006) Complications of laparoscopic bariatric surgery. In: Sugerman HJ, Nguyen NT (eds) Management of morbid obesity. Taylor & Francis, New York, pp 207–218Google Scholar
  8. 8.
    Nguyen NT, Goldman G, Rosenquist CJ et al (2002) Laparoscopic versus open gastric bypass: a randomized study of outcome, quality of line and costs. Ann Surg 234:279–291CrossRefGoogle Scholar
  9. 9.
    Nishida C, Uauy R, Kumanyka S, Hetty P (2004) The joint WHO/FAO expert consultation on diet, nutrition and the preventon of chronic diseases: process, product and policy implications. Public Health Nutr 7(1A):245–250PubMedGoogle Scholar
  10. 10.
    Deitel M (2003) Overweight and obesity worldwide now estimate to involve 1.7 billion people. Obes Surg 13:320–330Google Scholar
  11. 11.
    NIH Conference (1991) Gastrointestinal surgery for severe obesity. Consensus development conference panel. Ann Inter Med 115:956–961Google Scholar
  12. 12.
    American Society for Bariatric Surgery and the Society of American Gastrointestinal Endoscopic Surgeons (2000) Guidelines for laparoscopic and open surgical treatment of morbid obesity. Obes Surg 10:378–380CrossRefGoogle Scholar
  13. 13.
    Calle EE, Thun MJ, Petrelli JM et al (1999) Body Mass Index and mortality in a prospective cohort study of U.S. adults. N Engl J Med 341:197–1115CrossRefGoogle Scholar
  14. 14.
    Busetto L, Segato G, De Luca M et al (2004) Preoperative weight loss by intragastric balloon in super-obese patients treated with laparoscopic gastric banding: a case control study. Obes Surg 14:671–676PubMedCrossRefGoogle Scholar
  15. 15.
    Basu NN, Cottam S (2006) Abdominal compartment syndrome. Surgery 24:260–262Google Scholar
  16. 16.
    Pottecher T, Segura P, Launoy A (2001) Le syndrome du compartiment abdominal. Ann Chir 126:192–200PubMedCrossRefGoogle Scholar
  17. 17.
    Schumpelick V, Narbenhernie (2000) In: Schumpelick V (ed) Hernien. Thieme, Stuttgard, pp 266–269Google Scholar
  18. 18.
    Dietz UA, Hamelmann W, Winkler et al (2007) An alterantive classification of incisional hernias enlisting morphology, body type and risk factors in the assessment of prognosis and tailoring of surgical technique. J Plast Reconstruct Aesthet Surg 60:383–388CrossRefGoogle Scholar
  19. 19.
    Downey SE, Morales C, Kelso RL, Anthone G (2005) Review of technique for combined closed incisional hernia repair and panniculectomy status post-open bariatric surgery. Surg Obes Rel Dis 1:458–461CrossRefGoogle Scholar
  20. 20.
    Kendall SWH, Brennan TG, Guillou PJ (1991) Suture length to wound length ratio and the integritry of midline and lateral paramedian incision. Br J Surg 78:705–707PubMedCrossRefGoogle Scholar
  21. 21.
    Hashizume M, Migo S, Tsugawa Y et al (1996) Laparoscopic repair of paraumbilical ventral hernia with increasing size in an obese patient. Surg Endosc 10:933–935PubMedCrossRefGoogle Scholar
  22. 22.
    Bowser CE, Reade CC, Kirby LW, Roth JS (2004) Complications of laparoscopic incisional-ventral hernia repair. The experience of a single institution. Surg Endosc 18:672–675CrossRefGoogle Scholar
  23. 23.
    Bonatti H, Hoeller E, Kirchmayr W et al (2004) Ventral hernia repair in bariatric surgery Obes Surg 14:655–658PubMedCrossRefGoogle Scholar
  24. 24.
    Raftopoulos I, Vanuno D, Khorsand J et al (2002) Outcome of laparoscopic ventral hernia repair in correlation with obesity, type of hernia, and hernia size. J Laparoendosc Adv Surg Tech 12:425–429CrossRefGoogle Scholar
  25. 25.
    Anthony T, Bergren PC, Kim LT et al (2000) Factors affecting recurrence following incisional herniorraphy. World J Surg 24:95–101PubMedCrossRefGoogle Scholar
  26. 26.
    Liakatos T, Kararikas H, Panagiotidis H, Dendrinos S (1994) Use of marlex mesh in the repair of recurrent incisional hernia. Br J Surg 81:284–289Google Scholar
  27. 27.
    Rios A, Rodriguez JM, Munitz V et al (2001) Factors that affect recurrence after incisional herniorraphy with prosthetic material. Eur J Surg 167:855–859PubMedCrossRefGoogle Scholar
  28. 28.
    Genco A, Cipriano M, Bacci V et al (2006) BioEnterics Intragastric Balloon (BIB): a short-term, double-blind, randomised, controlled, crossover study on weight reduction in morbidly obese patients. Int J Obes 30:129–133CrossRefGoogle Scholar
  29. 29.
    Angrisani L, Lorenzo M, Borrelli V et al (2006) Is bariatric surgery necessary after intragastric balloon treatment? Obes Surg 16:1135–1137PubMedCrossRefGoogle Scholar
  30. 30.
    Eid GM, Mattar SG, Hamad G et al (2004) Repair of ventral hernias in morbidly obese patients undergoing laparoscopic gastric bypass should not be referred. Surg Endosc 18:207–210PubMedCrossRefGoogle Scholar
  31. 31.
    Costanza MJ, Heniford BT, Area MJ et al (1998) Laparoscopic repair of recurrent ventral hernias. Am Surg 64:1121–1127PubMedGoogle Scholar
  32. 32.
    Scott Helton W, Fisichella PM, Berger R et al (2005) Short-term outcomes with small intestinal submucosa for ventral abdominal hernia. Arch Surg 140:549–562PubMedCrossRefGoogle Scholar
  33. 33.
    Adedeji OA, Bailey CA, Varma JS (2002) Porcine dermal collagen graft in abdominal wall recontruction. Br J Plastic Surg 55:85–86CrossRefGoogle Scholar
  34. 34.
    Franklin ME Jr, Gonzalez JJ Jr, Glass JL (2004) Use of porcine small intestinal submucosa as a prosthetic device for laparoscopic repair of hernias in contaminated field: 2-year followup. Hernia 8:186–189PubMedGoogle Scholar
  35. 35.
    Armellino MF, De Stefano G, Scardi F et al (2006) Ľimpiego del Permacol nei laparoceli complicati. Chir Ital 58:627–630PubMedGoogle Scholar
  36. 36.
    Vix JR, Meyer C, Rohr S, Bourtoul C (1997) The treatment of incisional hernia with a prosthesis in potentially infected tissues — a series of 47 cases. Hernia 1:157–161CrossRefGoogle Scholar
  37. 37.
    DeMaria EJ, Moss EJ, Sugerman HJ (2000) Laparoscopic intraperitoneal politetrafluoroethylene (ptfe) prosthetic patch repair of ventral hernia. Surg Endosc 14:326–329PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2008

Authors and Affiliations

  • Luigi Angrisani
  • Michele Lorenzo
  • Pier Paolo Cutolo

There are no affiliations available

Personalised recommendations