title: Outcome of laparoscopic ventral hernia repair in morbidly obese patients with a body mass index exceeding 35 kg/m2.
abstract: BACKGROUND
  Laparoscopic ventral hernia repair (LVHR) for morbidly obese patients with a body mass index (BMI) exceeding 35 kg/m(2) has not been well investigated.
  
  
  METHODS
  Hernia recurrence was evaluated by surveillance computed tomography. A p value less than 0.05 was considered significant.
  
  
  RESULTS
  Between 2003 and 2006, LVHR was attempted for 27 patients with a BMI exceeding 35 kg/m(2). There was one conversion to open surgery (3.7%). The 27 patients included 8 men (29.6%) and 19 women (70.4%) with a mean age of 48 years (range, 33-73 years). The mean BMI was 46.9 kg/m(2) (range, 35-70 kg/m(2)). Nine patients (33%) were superobese (BMI > 50 kg/m(2)), and five patients (22.7%) underwent emergency LVHR because of small bowel obstruction. Concomitant LVHR with laparoscopic gastric bypass (LGB) was performed for 13 patients (48%). Primary, incisional, or recurrent incisional ventral hernia was present in 7 (26%), 15 (55%), and 5 (19%) patients, respectively. A large hernia (>50 cm(2)) was found in 20 patients (74%). The mesh used was porcine submucosal small intestine extracellular matrix for 15 patients (57%), Gore-Tex for 9 patients (35%), and Composix for 2 patients (8%). The mean hernia size was 158 cm(2 )(range, 12-806 cm(2)), and the mean mesh size was 374 cm(2) (range, 117-2,400 cm(2)). The mean operative time was 190 min (range, 80-480 min), and the mean hospital length of stay (LOS) was 3.6 days (range, 1-11 days). Minor or major complications occurred in seven patients (25.9%), and five patients (18.5%) experienced recurrence during a mean follow-up period of 14.9 months (range, 3-32 months). Emergency setting, BMI, concomitant LGB, hernia type, hernia size, and mesh type had no statistically significant effect on operative time, LOS, morbidity, or recurrence rates.
  
  
  CONCLUSIONS
  For morbidly obese patients, LVHR is safe and effective, but it is associated with higher likelihood of recurrence, and patients should be appropriately informed.
authors.affiliation: Division of Minimally Invasive, Bariatric, and General Surgery, UPMC Shadyside & Magee-Women's Hospitals, University of Pittsburgh, 5200 Centre Avenue, Suite 715, Pittsburgh, PA 15232, USA. raftopoulosi@upmc.edu
authors.forename: I
authors.initials: I
authors.lastname: Raftopoulos
authors.forename: A P
authors.initials: AP
authors.lastname: Courcoulas
mesh_terms: D000328:Adult; D000368:Aged; D001705:Bioprosthesis; D015992:Body Mass Index; D004638:Emergency Treatment; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass; D006555:Hernia, Ventral / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications* / Q000601:surgery; D012008:Recurrence; D013526:Surgical Mesh; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome