Laparoscopic Ventral Hernia Repair in Bariatric Patients: the Role of Defect Size and Deferred Repair

Abstract

Purpose: To analyze the safety of laparoscopic ventral hernia delayed repair in bariatric patients with a composite mesh.

Materials and methods: This retrospective single-center observational trial analyzed all bariatric/obese patients with concomitant ventral hernia who underwent laparoscopic abdominal hernia repair before bariatric surgery (group A) and laparoscopic delayed repair after weight loss obtained by the bariatric procedure (group B).

Results: Group A (30 patients) had a mean BMI of 37.8 ± 5.7 kg/m² (range: 34.0-74.2 kg/m²); group B (170 patients) had a mean BMI of 24.6 ± 4.5 kg/m² (range 19.0-29.8 kg/m²) (p < 0.05). Mean operative time: group A, 51.7 ± 26.6 min (range 30-120); group B 38.9 ± 21.5 min (range 25-110) (p < 0.05). Average length of stay: group A, 2.0 ± 2.7 days (range 1-5) versus group B, 2.8 ± 1.9 days (range 1-4) (p > 0.5). Recurrent hernia group A 1/30 (3.3%) versus recurrent hernia group B 4/170 (2.3%) (p > 0.5). Bulging: group A, 3/30 (10.0%) versus group B, 0/170 (0%) (p = 0.23).

Conclusion: The present study demonstrates the safety of performing LDR in patient candidates for bariatric surgery in cases of a large abdominal hernia (W2-W3) with a low risk of incarceration or an asymptomatic abdominal hernia. In the case of a small abdominal hernia (W1) or strongly symptomatic abdominal hernia, repair before bariatric surgery, along with subsequent bariatric surgery and any revision of the abdominal wall surgery with weight loss, is preferable.

Keywords: Bariatric surgery; Composite mesh; IPOM; Laparoscopic ventral hernia repair; Sleeve gastrectomy.