Concomitant Bariatric Surgery with Laparoscopic Intra-peritoneal Onlay Mesh Repair for Recurrent Ventral Hernias in Morbidly Obese Patients: an Evolving Standard of Care.
Repair of recurrent ventral hernias (RVHs) has a high failure rate more so in the presence of obesity. The chronic increase in intra-abdominal pressure (IAP) associated with obesity might, in part, be an important implicating factor that needs to be addressed in these patients. Laparoscopic ventral hernia repair (LVHR) done with concomitant bariatric surgery in morbidly obese patients with RVHs may avoid multiple failures. We report our preliminary experience in treating RVHs in morbidly obese patients with laparoscopic intra-peritoneal onlay mesh (IPOM) repair and concomitant bariatric surgery.



A retrospective review of all patients with a RVH who underwent concomitant bariatric surgery and laparoscopic IPOM repair at our institution from 2009 to 2013 was performed. Demographic, operative, postoperative, and follow-up data were collected.



There were 23 patients included in the study. The mean BMI was 43.24. Fifteen patients had a previous open mesh repair, and eight had a laparoscopic IPOM repair. The patients had a median of 2 previous repairs (range 1-5 repairs). A laparoscopic sleeve gastrectomy was performed in 22 patients, and a laparoscopic Roux-en-Y gastric bypass was performed in one. The mean operating time was 112 min (65-220 min). The mean hospital stay was 3.3 days (2-8 days). A seroma was noted in four patients. No mesh infection or recurrence was noted at a median follow-up of 3.3 years (9 months to 5.5 years).



Laparoscopic IPOM repair done with concomitant bariatric surgery in morbidly obese patients with RVHs seems promising with a low rate of early recurrence.
Department of Bariatric Surgery, Gem Hospital, Coimbatore, Tamil Nadu, India. praveenraj@me.com.
Palanivelu
P
Praveenraj
Department of Bariatric Surgery, Gem Hospital, Coimbatore, Tamil Nadu, India.
Rachel Maria
RM
Gomes
Department of Bariatric Surgery, Gem Hospital, Coimbatore, Tamil Nadu, India.
Saravana
S
Kumar
Department of Surgical Gastroenterology, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India.
Palanisamy
P
Senthilnathan
Department of Surgical Gastroenterology, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India.
Ramakrishnan
R
Parthasarathi
Department of Surgical Gastroenterology, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India.
Subbiah
S
Rajapandian
Department of Surgical Gastroenterology, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India.
Chinnusamy
C
Palanivelu
D000328:Adult; D050110:Bariatric Surgery / Q000379:methods; D005260:Female; D006555:Hernia, Ventral / Q000150:complications / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D059039:Standard of Care; D013526:Surgical Mesh; D016896:Treatment Outcome
Intra-abdominal pressure; Laparoscopic ventral hernia repair; Morbid obesity; Recurrent ventral hernias