Surgical synergy or complication catalyst? Evaluating a meta-analysis of concomitant bariatric surgery and ventral...

Obesity has become a global comorbidity with increasing prevalence over the last decade. It is associated with an elevated risk for the development of ventral hernias. Bariatric surgery aims to address obesity through surgical intervention, which has become increasingly safe over time. However, a comparative meta-analysis with a double-arm evaluation of concomitant ventral hernia repair (VHR) and weight loss surgery is not yet available in the literature. Hence, we performed a systematic review and meta-analysis of simultaneous VHR and bariatric surgery.

Cochrane, Embase, Scopus, Scielo, and PubMed were systematically searched for studies comparing concomitant bariatric surgery and VHR with bariatric surgery alone or staged repair. Outcomes assessed for comparative meta-analysis were surgical site infection (SSI), dehiscence, readmission and reoperation, deep venous thrombosis (DVT) and pulmonary embolism (PE), overall mortality, operative time, and length of hospital stay (LOS). SSI was also analyzed separately as a superficial or deep infection. We also performed a single-arm meta-analysis of incarceration within the staged repair groups with a bariatric surgery as the first procedure and a single-arm meta-analysis of recurrence following concomitant bariatric surgery and VHR. Statistical analysis was performed with R Studio.

805 studies were screened and 26 were thoroughly reviewed. Six studies were included, comprising a total of 131,323 patients, of whom 3002 (2.3%) underwent simultaneous bariatric and VHR procedures. Simultaneous repair was associated with an increase of 39.4 min (95% CI 26.17 to 52.63; p < 0.01) in the operative time. We found an increased readmission rate for the concomitant procedures (OR 1.48; 95% CI 1.1 to 1.99; p < 0.01), but no differences were found in reoperation rates (OR 2.97; 95% CI 1.0 to 8.84; p = 0.05). Concomitant procedures were also associated with higher DVT (OR 2.54; 95% CI 1.36 to 4.72; p < 0.01) and PE rates compared to separated procedures (OR 3.08; 95% CI 1.57 to 6.05; p < 0.01). No differences were found in overall SSI (OR 1.1; 95% CI 0.59 to 2.12; p = 0.74) and superficial (OR 0.94; 95% CI 0.48 to 1.84; p = 0.86) or deep (OR 7.02; 95% CI 0.36 to 136.1; p = 0.2) SSI. No statistically significant differences were found in dehiscence rates between the groups (OR 0.2; 95% CI 0.01 to 4.16; p = 0.3). Concomitant procedures were associated with an increase of 0.35 days in LOS (95% CI 0.1 to 0.59; p = 0.004) and with increased mortality odds (OR 3.99; 95% CI 1.92 to 8.3; p < 0.01). The proportional meta-analysis found an incarceration rate of 22.95 (95% CI 10.9 to 42) for the patients who delayed the VHR and a recurrence rate of 7.61 per 100 patients (95% CI 1.6 to 29.6) for the patients who underwent concomitant surgery.

Our systematic review and meta-analysis found an increase in DVT, PE, readmission, operative time, LOS, and mortality for concomitant procedures. Incarceration rates of 22.95 were found for delayed VHR. Further research is needed to analyze individual bariatric surgery and VHR techniques and draw a more precise conclusion on this subject.