title: Concurrent ventral hernia repair in patients undergoing laparoscopic bariatric surgery: a case-matched study using the National Surgical Quality Improvement Program Database.
abstract: BACKGROUND
  There is no consensus regarding the optimal management of ventral hernias encountered during bariatric surgery.
  
  
  OBJECTIVE
  To compare early patient morbidity and mortality between those patients undergoing laparoscopic bariatric surgery only and those patients undergoing laparoscopic bariatric surgery with concomitant ventral hernia repair.
  
  
  METHODS
  American College of Surgeons National Surgical Quality Improvement Program Database (NSQIP).
  
  
  METHODS
  All patients undergoing laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy from 2012-2013 were identified within the NSQIP database. Those patients undergoing concomitant ventral hernia repair were compared with patients undergoing bariatric surgery only using a 1:1 matched analysis. Primary outcomes of interest included differences in 30-day composite adverse events, unplanned 30-day reoperation, and unplanned 30-day readmission to the hospital.
  
  
  RESULTS
  A total of 27,608 patients underwent laparoscopic bariatric surgery during the study period; 988 (3.6%) patients underwent concomitant ventral hernia repair. After 1:1 matching, 1976 patients were evaluated. In terms of 30-day patient morbidity, patients who underwent concomitant ventral hernia were significantly more likely to experience all primary outcomes of interest, including composite adverse events (P = .01), a higher rate of unplanned return to the operating room (P<.001), and a higher 30-day readmission rate (P = .01).
  
  
  CONCLUSIONS
  Although we were unable to assess specific hernia characteristics from the NSQIP database, patients who underwent concomitant ventral hernia repair with laparoscopic bariatric surgery experience increased 30-day morbidity. Optimal management of concurrent ventral hernias and timing of repair in bariatric surgical patients requires further investigation.
authors.affiliation: Bariatric and Metabolic Institute, Department of Surgery, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Zhamak
authors.initials: Z
authors.lastname: Khorgami
authors.affiliation: Comprehensive Hernia Center, Department of Surgery, Cleveland Clinic Foundation, Cleveland, Ohio; Department of Surgery, George Washington University, Washington, DC.
authors.forename: Ivy N
authors.initials: IN
authors.lastname: Haskins
authors.affiliation: Bariatric and Metabolic Institute, Department of Surgery, Cleveland Clinic Foundation, Cleveland, Ohio. Electronic address: aminiaa@ccf.org.
authors.forename: Ali
authors.initials: A
authors.lastname: Aminian
authors.affiliation: Department of Surgery, McGill University, Montreal, Quebec, Canada.
authors.forename: Amin
authors.initials: A
authors.lastname: Andalib
authors.affiliation: Comprehensive Hernia Center, Department of Surgery, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Rosen
authors.affiliation: Bariatric and Metabolic Institute, Department of Surgery, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Stacy A
authors.initials: SA
authors.lastname: Brethauer
authors.affiliation: Bariatric and Metabolic Institute, Department of Surgery, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Philip R
authors.initials: PR
authors.lastname: Schauer
mesh_terms: D050110:Bariatric Surgery / Q000379:methods* / Q000401:mortality; D003131:Combined Modality Therapy; D005260:Female; D005743:Gastrectomy / Q000379:methods / Q000401:mortality; D015390:Gastric Bypass / Q000379:methods; D006555:Hernia, Ventral / Q000150:complications / Q000401:mortality / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods* / Q000401:mortality; D006801:Humans; D010535:Laparoscopy / Q000379:methods / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000401:mortality / Q000601:surgery*; D010359:Patient Readmission / Q000706:statistics & numerical data; D058996:Quality Improvement; D012086:Reoperation / Q000706:statistics & numerical data
keywords: Bariatric Surgery; Gastric Bypass; Hernia; Sleeve Gastrectomy; Ventral Hernia