Outcomes in complex ventral hernia repair with anterior component separation in class III obesity patients

Consensus guidelines recommend against elective ventral hernia repair (VHR) in patients with BMI >30 kg/m² without preoperative weight loss intervention. We aim to compare hernia recurrence and perioperative complications in VHR utilizing anterior component separation (CS) in patients with class III obesity (BMI >40 kg/m²).

A retrospective review of patients undergoing VHR with CS was performed. The primary endpoint was hernia recurrence; secondary endpoints were wound complications, postoperative medical complications, mortality and length of stay.

185 consecutive patients were identified from 2008 to 2016. There were no significant differences between groups: hernia recurrence (6.9% BMI >40 kg/m², 2.4% BMI <39.9 kg/m², p = 0.21), wound complications (58.6% BMI >40 kg/m², 47.2% BMI <39.9 kg/m², p = 0.16), postoperative complications (39.7% BMI >40 kg/m², 26% BMI <39.9 kg/m², p = 0.08), mortality (1.6% BMI >40 kg/m², 3.4% BMI <39.9 kg/m², p = 0.59), and length of stay (10.6 days BMI >40 kg/m², 11.2 days BMI <39.9 kg/m², p = 0.5).

This study demonstrates similar outcomes in class III obesity patients undergoing elective VHR compared to patients with BMI <39.9 kg/m².