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. 2019 Aug 28;5(3):e87-e91.
doi: 10.1055/s-0039-1694979. eCollection 2019 Jul.

Laparoscopic Ventral Hernia Repair Combined with Sleeve Gastrectomy in Morbidly Obese Patients: Early Outcomes

Ahmed M S M Marzouk  1   2   3 , Heba O E Ali  4   5
Affiliations

Laparoscopic Ventral Hernia Repair Combined with Sleeve Gastrectomy in Morbidly Obese Patients: Early Outcomes

Ahmed M S M Marzouk et al. Surg J (N Y). .

Abstract

Background Morbid obesity is a serious chronic condition with, among other symptoms, increased intra-abdominal pressure and subsequent abdominal wall hernias. The optimal management of these manifestations is still controversial. The objective of this study was to assess the early postoperative outcomes of a surgical approach combining laparoscopic ventral hernia repair (LVHR) with sleeve gastrectomy in morbidly obese patients. Methods In this retrospective study, we reviewed the files of patients who are obese with a primary ventral hernia of less than 10 cm in diameter who received simultaneous laparoscopic sleeve gastrectomy and LVHR at our institution between February 2016 and July 2018. LVHR was performed using an intraperitoneal only mesh. The individual mesh size was chosen based on the number and size of the defects. Clinical and radiological follow-ups were performed between 9 and 15 months. Results A total of 15 patients were included. Five of them were males. The mean body mass index was 45.2 kg/m 2 (range: 38.7-56.2 kg/m 2 ). The mean hernia defect size was 2.6 cm (range: 1.3-4.2 cm). Mesh size was 10 × 15 cm in five, 20 × 15 cm in seven, and 25 cm× 20 cm in three patients. All patients were discharged without complications on the second postoperative day. Mean follow-up was at 12 months. One patient presented with hernia recurrence 14 months after surgery and four patients presented with self-limited seroma. Conclusion Despite ambiguous guidelines and ongoing debate regarding simultaneous bariatric surgery and ventral hernia repair, the short-term outcomes of this approach appeared promising, provided that patients are carefully selected and receive an individually tailored approach.

Keywords: hernia; laparoscopic ventral hernia repair; morbid obesity; sleeve gastrectomy.

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Conflict of interest statement

Conflict of Interest None declared.

Figures

Fig. 1
Fig. 1
Preoperative axial ( A ) and sagittal ( B ) computed tomography assessment of midline defects in a male patient with BMI, 56.2 kg/m 2 . Supraumbilical hernia with defect measuring 21.6 mm with omentum as its content is seen. Subtle soft tissue thickening seen in the inferior aspect of hernia sac (arrowed). BMI, body mass index.
Fig. 2
Fig. 2
Intraoperative view: laparoscopic ventral hernia repair was performed using intraperitoneal onlay mesh covering an at least 5 cm margin around the defect(s). The composite mesh was fixed with an absorbable fixation device and transfascial sutures.
Fig. 3
Fig. 3
Bar chart showing different mesh sizes used for hernia repair according to defect size.
Fig. 4
Fig. 4
Comparison of mean operation time between laparoscopic sleeve gastrectomy only and sleeve gastrectomy combined with hernia repair.
See this image and copyright information in PMC

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