title: Is the use of prosthetic mesh recommended in severely obese patients undergoing concomitant abdominal wall hernia repair and sleeve gastrectomy?
abstract: BACKGROUND
  The concomitant use of nonabsorbable mesh during stapled bariatric surgery has been discouraged due to potential contamination. The aim of our study was to compare and quantify the extent of bacterial load and gross contamination of the peritoneal cavity in patients undergoing laparoscopic sleeve gastrectomy (LSG) vs those undergoing laparoscopic Roux-en-Y gastric bypass (LRYGB).
  
  
  METHODS
  We prospectively enrolled all patients undergoing LSG and LRYGB. Peritoneal fluid aspirate samples were collected from each subject. Sample A was obtained at the beginning of the procedure, and sample B was obtained at the end of the procedure either from the staple line wash of the LSG or the gastrojejunostomy in the LRYGB.
  
  
  RESULTS
  A total of 77 patients (51 LSG and 26 LRYGB) and 154 samples (102 from LSG and 52 from LRYGB) were included in this study. All samples obtained at the beginning of each procedure (sample A) were culture negative. Samples of peritoneal fluid obtained at the end of the procedure (sample B) in sleeve gastrectomy procedures were all negative (0%) after a minimum of 72 hours for aerobic and anaerobic cultures. Those obtained for LRYGB (sample B) were culture positive in 4 of 26 (15%). The latter results are statistically significant (p < 0.05).
  
  
  CONCLUSIONS
  Intraperitoneal bacterial cultures in patients undergoing LSG are negative, contrary to those in patients undergoing LRYGB. The concomitant use of prosthetic material to repair ventral hernias in patients undergoing an LSG procedure should be safe and feasible.
authors.affiliation: The Bariatric and Metabolic Institute and the Section of Minimally Invasive and Endoscopic Surgery, Cleveland Clinic Florida, Weston, FL.
authors.forename: Yaniv
authors.initials: Y
authors.lastname: Cozacov
authors.affiliation: The Bariatric and Metabolic Institute and the Section of Minimally Invasive and Endoscopic Surgery, Cleveland Clinic Florida, Weston, FL.
authors.forename: Samuel
authors.initials: S
authors.lastname: Szomstein
authors.affiliation: The Bariatric and Metabolic Institute and the Section of Minimally Invasive and Endoscopic Surgery, Cleveland Clinic Florida, Weston, FL.
authors.forename: Fernando M
authors.initials: FM
authors.lastname: Safdie
authors.affiliation: The Bariatric and Metabolic Institute and the Section of Minimally Invasive and Endoscopic Surgery, Cleveland Clinic Florida, Weston, FL.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Lo Menzo
authors.affiliation: The Bariatric and Metabolic Institute and the Section of Minimally Invasive and Endoscopic Surgery, Cleveland Clinic Florida, Weston, FL. Electronic address: rosentr@ccf.org.
authors.forename: Raul
authors.initials: R
authors.lastname: Rosenthal
mesh_terms: D000328:Adult; D019072:Antibiotic Prophylaxis; D004866:Equipment Contamination; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D015390:Gastric Bypass / Q000379:methods*; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000601:surgery*; D010537:Peritoneum / Q000382:microbiology*; D011446:Prospective Studies; D013526:Surgical Mesh; D016896:Treatment Outcome