Paraumbilical hernia repair under local anaesthesia is feasible in overweight and obese patients

Background Body mass index (BMI) thresholds are utilized as a preoperative optimization strategy for obese patients prior to elective abdominal wall hernia repair. The objectives of this study were to determine the proportion of patients at our institution who ultimately underwent hernia repair after initial deferral due to BMI and to evaluate outcomes of those who required emergent repair during the deferral period. Methods A retrospective review was performed from 2016 to 2018 to identify all patients with abdominal wall hernias who were deferred surgery due to BMI. Patient characteristics, hernia type, change in BMI, progression to surgery, acuity of surgery (elective or emergent), and postoperative outcomes were examined. Results 200 patients were deferred hernia repair due to BMI. Of these, 150 (75%) did not undergo repair over a mean period of 27 months. The remaining 50 patients ultimately underwent repair, 36 of which (72%) were elective and 14 (28%) emergent. The mean initial BMI of the elective group was 35.3 ± 1.8, compared to 39.1 ± 5.3 in the no surgery group and 40.6 ± 8.2 in the emergent group ( P < .01). While the elective group lost weight before surgery, the other groups did not. Patients who required emergent surgery had worse outcomes than those repaired electively. Conclusions Preoperative weight loss is unsuccessful in most obese patients presenting for abdominal wall hernia repair at our institution. Patients who required emergent hernia repair had worse outcomes than those who underwent elective repair. Our institution’s BMI threshold is a failed optimization strategy that needs to be reconsidered.

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Sutureless Laparoscopic Ventral Hernia Repair in Obese Patients

JSLS Journal of the Society of Laparoendoscopic Surgeons ◽

10.4293/108680811x13022985131859 ◽

2011 ◽

Vol 15 (2) ◽

pp. 154-159 ◽

Cited By ~ 1

Author(s):

Ehab Akkary ◽

Lucian Panait ◽

Kurt Roberts ◽

Andrew Duffy ◽

Robert Bell

Keyword(s):

Hernia Repair ◽

Ventral Hernia ◽

Ventral Hernia Repair ◽

Laparoscopic Ventral Hernia Repair ◽

Obese Patients

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Laparoscopic Ventral Hernia Repair Combined with Sleeve Gastrectomy in Morbidly Obese Patients: Early Outcomes

The Surgery Journal ◽

10.1055/s-0039-1694979 ◽

2019 ◽

Vol 05 (03) ◽

pp. e87-e91 ◽

Cited By ~ 2

Author(s):

Ahmed M.S.M. Marzouk ◽

Heba O.E. Ali

Keyword(s):

Sleeve Gastrectomy ◽

Hernia Repair ◽

Ventral Hernia ◽

Ventral Hernia Repair ◽

Mesh Size ◽

Laparoscopic Ventral Hernia Repair ◽

Abdominal Pressure ◽

Morbidly Obese ◽

Obese Patients ◽

The Mean

Background Morbid obesity is a serious chronic condition with, among other symptoms, increased intra-abdominal pressure and subsequent abdominal wall hernias. The optimal management of these manifestations is still controversial. The objective of this study was to assess the early postoperative outcomes of a surgical approach combining laparoscopic ventral hernia repair (LVHR) with sleeve gastrectomy in morbidly obese patients. Methods In this retrospective study, we reviewed the files of patients who are obese with a primary ventral hernia of less than 10 cm in diameter who received simultaneous laparoscopic sleeve gastrectomy and LVHR at our institution between February 2016 and July 2018. LVHR was performed using an intraperitoneal only mesh. The individual mesh size was chosen based on the number and size of the defects. Clinical and radiological follow-ups were performed between 9 and 15 months. Results A total of 15 patients were included. Five of them were males. The mean body mass index was 45.2 kg/m2 (range: 38.7–56.2 kg/m2). The mean hernia defect size was 2.6 cm (range: 1.3–4.2 cm). Mesh size was 10 × 15 cm in five, 20 × 15 cm in seven, and 25 cm× 20 cm in three patients. All patients were discharged without complications on the second postoperative day. Mean follow-up was at 12 months. One patient presented with hernia recurrence 14 months after surgery and four patients presented with self-limited seroma. Conclusion Despite ambiguous guidelines and ongoing debate regarding simultaneous bariatric surgery and ventral hernia repair, the short-term outcomes of this approach appeared promising, provided that patients are carefully selected and receive an individually tailored approach.

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