Repair of ventral hernias in morbidly obese patients undergoing laparoscopic gastric bypass should not be deferred
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Laparoscopic Repair of Para-Esophageal Hernia Using Absorbable Biosynthetic Mesh
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1Minimally Invasive Center, Department of Surgery, University of Pittsburgh Medical Center, Suite 5500, Magee-Women's Hospital, 300 Halket Street, Pittsburgh, PA 15213, USA. eidgm@msx.upmc.edu
Background:
There is no consensus regarding the optimal treatment of ventral hernias in patients who present for weight loss surgery.
Methods:
Medical records of consecutive morbidly obese patients who underwent laparoscopic Roux-en-Y (LRYGB) gastric bypass with a secondary diagnosis of ventral hernia were reviewed. Only patients who were beyond 6 months of follow-up were included.
Results:
The study population was 85 patients. There were three groups of patients according to the method of repair: primary repair (59), small intestine submucosa (SIS) (12), and deferred treatment (14). Average follow-up was 26 months. There was a 22% recurrence in the primary repair group. There were no recurrences in the SIS group. Five of the patients in the deferred treatment group (37.5%) presented with small bowel obstruction due to incarceration.
Conclusion:
Biomaterial mesh (SIS) repair of ventral hernias concomitant with LRYGB resulted in the most favorable outcome albeit having short follow-up. Concomitant primary repair is associated with a high rate of recurrence. All incarcerated ventral hernias should be repaired concomitant with LRYGB, as deferment may result in small bowel obstruction.
