Is simultaneous bariatric surgery and ventral hernia repair a safe and effective approach?

Abstract

Background: There is currently a lack of consensus regarding the timing of ventral hernia repair relative to bariatric surgery.

Objectives: To compare outcomes between patients undergoing simultaneous and selectively deferred ventral hernia repair and bariatric surgery.

Setting: High volume UPPER gastrointestinal and Bariatric Unit. Sydney, Australia.

Methods: A retrospective case series from a single institution's prospectively collected database (2003-21) was performed to determine the characteristics and outcomes in patients having simultaneous and deferred hernia repair relative to their bariatric surgery.

Results: In our patient cohort (N = 134), 111 patients underwent simultaneous repair and 23 had a deferred procedure. Of the simultaneous patients, 95 (85.6%) underwent resection bariatric surgery. The median operative time in the simultaneous versus deferred groups was 155 versus 287 minutes and the length of stay was 3 versus 7 days. There has been one (.9%) mesh infection requiring explant, in an open, simultaneous repair undertaken in a gastric band patient, 3 (2.8%) infected seromas, 1 (.9%) surgical site infection, and 8 (7.5%) hernia recurrences in the simultaneous group. The deferred group has had no mesh infections, no hernia recurrence, and 2 (9.5%) infected seromas to date. There was 1 mortality in the simultaneous cohort (simultaneous gastric bypass group), from a massive Pulmonary Embolism (<30 days postoperatively) and one in the deferred group from an interval small bowel obstruction.

Conclusions: Simultaneous ventral hernia repair with bariatric surgery had a low rate of infection and a low mesh explant rate, even when coupled with resection bariatric surgery in this series. A combined approach may be safe, even in the clean-contaminated surgical context.

Keywords: Bariatric surgery; Hernia repair; Upper gastrointestinal.