Concomitant bariatric surgery and hernia repair: A Data-Driven answer to a longstanding surgical dilemma

To evaluate the safety, efficacy, and long-term outcomes of concomitant laparoscopic bariatric surgery and ventral hernia repair in obese patients. Obesity and ventral hernia frequently coexist, often presenting a surgical dilemma. Historically, concerns over mesh infections, extended operative time, and increased morbidity have led to a preference for staged procedures. However, with advancements in laparoscopic techniques and increasing evidence supporting mesh placement in clean-contaminated fields, the concomitant approach has gained acceptance. High-quality data from large-volume centers remain limited till now.

This retrospective study was conducted at a tertiary care center between January 2003 and December 2023. A total of 353 patients underwent simultaneous bariatric surgery-either laparoscopic sleeve gastrectomy (LSG), Roux-en-Y gastric bypass (LRYGB), or mini-gastric bypass (MGB-OAGB)-with ventral hernia repair using intraperitoneal onlay mesh (IPOM), eTEP-Ventral RS, or eTEP-TAR techniques. The Primary objective of the study was to assess the complication and recurrence rates. Secondary objective included operative time, hospital stay, and postoperative recovery.

Of the 353 patients, 224 underwent LSG, 74 LRYGB, and 55 MGB-OAGB. IPOM was used in 90% of cases. The overall complication rate was low, with seroma (2.3%), ileus (2.6%), hematoma (1.1%) and Surgical site occurrences (SSO) (3.4%) being the most common. No mesh infections or anastomotic leaks were observed. Mean operative time ranged from 124 to 167 min, and average hospital stay was 3.1 ± 1.1 days. At one-year follow-up in 268 patients (80%), hernia recurrence was 0.6%.

Concomitant laparoscopic bariatric surgery with hernia repair is a safe and effective option in appropriately selected patients, with excellent outcomes and minimal complications.