Hernia repair and abdominoplasty in gastric bypass patients.
BACKGROUND
Patients who sustain massive weight loss after open gastric bypass surgery are prone to incisional hernias. The authors undertook a retrospective study with two objectives: to characterize this patient population at their institution and to review their experience with treatment of incisional hernias in massive weight loss patients who had open gastric bypass surgery. With increasing prevalence of such patients, the authors aim to improve understanding and treatment of this disease entity and thereby improve patient outcomes.


METHODS
Operating room records and the patient database of the primary plastic surgeon treating massive weight loss patients at an academic teaching institution were retrospectively reviewed. Incisional hernia was often diagnosed before surgery but confirmed intraoperatively. Surgical management included primary repair of the hernia with plication of the abdominal wall from xiphoid to pubis and removal of redundant abdominal skin.


RESULTS
From February of 2001 to December of 2003, 40 patients had hernia repair in combination with abdominoplasty. Average age was 42 years, and average weight loss was 152 pounds. Average body mass index at the time of plastic surgery was 35.6. Average abdominal skin resection was 9.9 pounds. Hernia recurred in one patient with a body mass index of 41.3 after heavy lifting within 1 year of hernia repair surgery. Other complications included wound-healing problems (20 percent); seroma (12.5 percent); bleeding requiring surgical take-back (2.5 percent); suture abscess requiring surgical removal of suture (7.5 percent); bleeding anastomotic ulcer requiring transfusion (2.5 percent); and fatal pulmonary embolus (2.5 percent). Of the group, 60 percent had uncomplicated healing.


CONCLUSIONS
Hernias are safely and preferentially repaired at the time of removal of redundant abdominal panniculus after massive weight loss sustained from gastric bypass surgery. The authors present their approach to hernia repair and abdominoplasty in this patient group, with acceptable results.
Shermak
Michele A
MA
Division of Plastic Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD, USA. masherma@jhmi.edu
D000009:Abdominal Muscles / Q000601:surgery*; D000328:Adult; D015897:Comorbidity; D000071938:Fasciotomy; D005260:Female; D015390:Gastric Bypass; D046449:Hernia, Abdominal / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology; D012008:Recurrence; D012189:Retrospective Studies; D049291:Seroma / Q000453:epidemiology; D013536:Suture Techniques; D015431:Weight Loss