title: Synchronous Ventral Hernia Repair in Patients Undergoing Bariatric Surgery.
abstract: BACKGROUND
  Obesity predisposes patients to abdominal wall hernias. Patients undergoing bariatric surgery are not uncommonly found to have ventral hernias. Synchronous ventral hernia repair (S-VHR) has been reported in 2-5% of patients undergoing bariatric surgery. Studies reporting on the outcomes of S-VHR are limited by sample size. The aim of this study was to assess the effect of S-VHR on surgical site infection (SSI) rate.
  
  
  METHODS
  The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2010 to 2011 was queried using Current Procedural Terminology codes for bariatric surgery. Data on patient demographics, comorbidities, procedural events, and postoperative occurrences were analyzed. Thirty-day mortality and morbidity were assessed. Comparisons between laparoscopic Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) were performed.
  
  
  RESULTS
  We identified 17,117 patients who underwent RYGB or SG. S-VHR was performed in 503 (2.94%) patients. S-VHR was independently associated with SSI (odds ratios (OR) 1.65, 95% confidence interval (CI) 1.06-2.58), but not overall morbidity (OR 1.33, 95% CI 0.96-1.86). Four hundred thirty-three patients with RYGB and 70 with SG had S-VHR. Serious morbidity (3.5 vs. 5.7%, p = 0.32) and overall morbidity (8.3 vs. 8.6%, p = 0.942) were similar. After controlling for baseline comorbidities, there was no significant effect of procedure type on SSI (OR 0.38, 95% CI 0.05-2.91).
  
  
  CONCLUSIONS
  S-VHR is associated with an increase in SSI but not overall morbidity. There is no significant difference in the SSI rate between RYGB and SG. Larger studies are needed to definitively assess a potential difference in the wound infection rate between RYGB and SG.
authors.affiliation: Department of Surgery, The Brody School of Medicine at East Carolina University, Greenville, NC, USA, SPANIOLASK@ecu.edu.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Spaniolas
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Kasten
authors.forename: Anthony B
authors.initials: AB
authors.lastname: Mozer
authors.forename: Megan E
authors.initials: ME
authors.lastname: Sippey
authors.forename: William H H
authors.initials: WH
authors.lastname: Chapman
authors.forename: Walter J
authors.initials: WJ
authors.lastname: Pories
authors.forename: John R
authors.initials: JR
authors.lastname: Pender
mesh_terms: D000328:Adult; D000368:Aged; D050110:Bariatric Surgery / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D015390:Gastric Bypass / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D006555:Hernia, Ventral / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009767:Obesity, Morbid / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology*