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Simultaneous Complex Incisional Hernia Repair and Bariatric Surgery for Obese Patients: a Case Series of a
Juan Carlos Sebastián-Tomás1, José Ángel Díez-Ares1, Nuria Peris-Tomás1
1Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain.
Insights
Combining bariatric procedures with complex incisional hernia repair (CIHR) in obese patients appears safe and feasible. This approach may reduce recurrence rates for complex incisional hernias, offering a viable surgical option.
Area of Science:
- Surgical innovation in bariatric surgery and hernia repair.
- Obesity management and its impact on surgical outcomes.
Background:
- Obesity is a significant risk factor for complex incisional hernia repair (CIHR) recurrence.
- Simultaneous bariatric procedures during CIHR may offer improved outcomes.
Purpose of the Study:
- To evaluate the feasibility and safety of combining bariatric procedures with CIHR in obese patients.
- To assess short-term recurrence and morbidity rates in this patient cohort.
Main Methods:
- Retrospective observational study of patients with complex incisional hernia (CIH) and BMI ≥35.
- Data collected included demographics, comorbidities, CIH classification, bariatric procedure type, and postoperative morbidity (Dindo-Clavien).
- Preoperative CT scans assessed abdominal wall defect size.
Main Results:
- Ten obese patients (mean BMI 43.63) underwent CIHR with simultaneous bariatric procedures.
- All CIHs were classified as W2 or higher (European Hernia Society).
- One major complication (gastric leak) occurred; one recurrence was observed at 1-year follow-up with 24.04% total weight loss.
Conclusions:
- Simultaneous bariatric procedures during CIHR in obese patients are feasible and safe.
- This combined approach may be a beneficial surgical option for selected patients.
- Further research is warranted to confirm long-term efficacy and recurrence rates.
Purpose:
Obesity is associated with recurrence of complex incisional hernia repair (CIHR). Bariatric procedure during CIHR can improve recurrence rates without increasing morbidity. This study aimed to describe our results after CIHR in patients with obesity, in which a simultaneous bariatric procedure was performed.
Materials And Methods:
We performed a retrospective observational study including patients who underwent surgery between January 2014 and December 2018, with a complex incisional hernia (CIH) according to the Slater classification and body mass index (BMI) ≥35. CIHR was the main indication for surgery. We collected demographic data, comorbidities, CIH classification according to the European Hernia Society, type of bariatric procedure, postoperative morbidity using the Dindo-Clavien classification, and short-term results. Computed tomography (CT) is performed preoperatively.
Results:
Ten patients were included in the study (7 women). The mean BMI was 43.63±4.91 kg/m2. The size of the abdominal wall defect on CT was 8.86±3.93 cm. According to the European Hernia Society classification, all CIHs were W2 or higher. Prosthetic repair of the CIH was selected. Onlay, sublay, preperitoneal, and inlay mesh placement were performed twice each, as well as one modified component separation technique and one transversus abdominis release. Gastric leak after sleeve gastrectomy was the only major complication. Short-term outcomes included one recurrence, and % total weight loss was 24.04±8.03 after 1-year follow-up.
Conclusion:
The association of bariatric procedures during CIHR seems to be feasible, safe, and could be an option for surgical treatment in selected patients.
