Management of ventral hernias during laparoscopic gastric bypass

Despite the relatively high incidence of ventral hernias in the morbidly obese, their management in bariatric surgery patients remains difficult and controversial. We sought to define a rational approach to ventral hernia management in the gastric bypass patient in a university hospital setting.

We performed a retrospective, single-institution analysis of all patients who had undergone concomitant ventral hernia repair (VHR) during antecolic gastric bypass.

A total of 325 consecutive patients underwent laparoscopic gastric bypass, and 26 (8%) had a ventral hernia found at laparoscopic gastric bypass. In 8 select patients, the incarcerated omental hernia contents were left in situ, and their VHR was successfully deferred. Of the remaining 15 patients, 8 underwent primary VHR and 10 underwent VHR with prosthetic mesh (Proceed). The average length of hospital stay for the VHR versus non-VHR repair groups was 1.6 and 2.7 days, respectively. The only predictor for an increased length of hospital stay was hernia repair with mesh (odds ratio 9.2, P = .002). The average follow-up was 14 months (range 4-30 months). Of the 8 patients who had undergone primary repair, 2 presented with a postoperative small bowel obstruction at the site of their VHR. None of the patients who underwent VHR with prosthetic mesh developed an obstruction or clinical evidence of recurrence or infection.

In this small study, primary VHR was associated with a high incidence of small bowel obstruction. Prosthetic mesh repair of ventral hernias during LGB did not result in any infection, although the length of hospital stay was increased. In select patients, deferral might be safe.