Bariatric Surgery: Bridge for Ventral Hernia Repair?

Background: Obesity increases the risks for perioperative complications and recurrence after ventral hernia repairs (VHR). The effect of bariatric surgery itself on VHR has not been widely studied. This study uses the MarketScan^® database to evaluate the outcomes of elective VHR following a history of bariatric surgery. Methods: IBM MarketScan^® Commercial Database (2000-2021) was used to identify elective VHR patients with a history of bariatric surgery (bariatric group) or without but were otherwise obese (obese control group). Propensity score weighting was used to balance the measured confounders. Postoperative complications at 30 days and hernia reoperations at 1, 3, and 5 years were compared. Results: 10,468 patients were included in the study. 55.9% of patients in the bariatric group were still obese at the time of VHR. The bariatric group had a lower Charlson Comorbidity Index but noted higher incidences of concurrent operations during VHR. The bariatric group had a higher incidence of incision and drainage for hematomas/seromas (3.7% vs 2.3%, P < .01) and higher hernia reoperation at 1, 3, and 5 years postoperatively (7.8% vs 5.5%, 12.9% vs 9.9%, and 14.7% vs 11%, P < .01). Discussion: Our retrospective database study showed that patients with a history of bariatric surgery had a higher risk of hernia reoperations after VHR than those without. This indicates that although weight loss itself may reduce the risks of VHR, there may be additional effects of bariatric surgery and weight loss that need to be carefully considered.