Repair of ventral hernias in morbidly obese patients undergoing laparoscopic gastric bypass should not be deferred.
BACKGROUND
There is no consensus regarding the optimal treatment of ventral hernias in patients who present for weight loss surgery.


METHODS
Medical records of consecutive morbidly obese patients who underwent laparoscopic Roux-en-Y (LRYGB) gastric bypass with a secondary diagnosis of ventral hernia were reviewed. Only patients who were beyond 6 months of follow-up were included.


RESULTS
The study population was 85 patients. There were three groups of patients according to the method of repair: primary repair (59), small intestine submucosa (SIS) (12), and deferred treatment (14). Average follow-up was 26 months. There was a 22% recurrence in the primary repair group. There were no recurrences in the SIS group. Five of the patients in the deferred treatment group (37.5%) presented with small bowel obstruction due to incarceration.


CONCLUSIONS
Biomaterial mesh (SIS) repair of ventral hernias concomitant with LRYGB resulted in the most favorable outcome albeit having short follow-up. Concomitant primary repair is associated with a high rate of recurrence. All incarcerated ventral hernias should be repaired concomitant with LRYGB, as deferment may result in small bowel obstruction.
Eid
G M
GM
Minimally Invasive Center, Department of Surgery, University of Pittsburgh Medical Center, Suite 5500, Magee-Women's Hospital, 300 Halket Street, Pittsburgh, PA 15213, USA. eidgm@msx.upmc.edu
Mattar
S G
SG
Hamad
G
G
Cottam
D R
DR
Lord
J L
JL
Watson
A
A
Dallal
R M
RM
Schauer
P R
PR
Dallal
M
M
D000328:Adult; D000713:Anastomosis, Roux-en-Y; D015992:Body Mass Index; D016208:Databases, Factual; D004630:Emergencies; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass; D015391:Gastroplasty / Q000379:methods; D006554:Hernia, Umbilical / Q000150:complications / Q000601:surgery*; D006555:Hernia, Ventral / Q000150:complications / Q000601:surgery*; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000517:prevention & control / Q000601:surgery; D007421:Intestine, Small / Q000601:surgery; D007422:Intestines / Q000098:blood supply; D007511:Ischemia / Q000209:etiology / Q000517:prevention & control; D010535:Laparoscopy / Q000379:methods; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D019736:Prostheses and Implants; D019919:Prosthesis Implantation / Q000379:methods / Q000706:statistics & numerical data; D012008:Recurrence; D013314:Stress, Mechanical; D013526:Surgical Mesh; D013536:Suture Techniques; D013997:Time Factors