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Talbot ML, Khanna S. Reply to comment on is simultaneous bariatric surgery and ventral hernia repair a safe and effective approach? Surg Obes Relat Dis 2024; 20:597. [PMID: 38614925 DOI: 10.1016/j.soard.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 02/17/2024] [Indexed: 04/15/2024]
Affiliation(s)
- Michael Leonard Talbot
- Upper Gastrointestinal Surgery Unit, St George Hospital, Sydney, New South Wales, Australia; UNSW Department of Surgery and St George Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Sukrit Khanna
- UNSW Department of Surgery and St George Clinical School, University of New South Wales, Sydney, New South Wales, Australia
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Turmine J, Florence AM, Tardivon C, Passot G, Gillion JF, Moszkowicz D. Obesity increases the surgical complexity and risk of recurrence after midline primary ventral hernia repair: results on 2307 patients from the French Society of hernia surgery (SFCP-CH) registry database. Hernia 2024; 28:779-788. [PMID: 37702874 DOI: 10.1007/s10029-023-02875-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 08/28/2023] [Indexed: 09/14/2023]
Abstract
PURPOSE Obesity is a known risk factor of recurrence after hernia surgery, but available data often concern pooled cases of primary and incisional hernia, with short follow-up. We aimed to analyze the impact of severe obesity (BMI ≥ 35 kg/m2) on the results of midline primary ventral hernia repair (mPVHR), in comparison with non-severely obese patients. METHODS Data were extracted from a multicentric registry, in which patients' data are consecutively and anonymously collected. We conducted a retrospective comparative study on patients with severe obesity (sOb) versus non-severely obese patients (non-sOb), who underwent surgery, with a minimal 2-year follow-up after their mPVHR. RESULTS Among 2307 patients, 267 sOb and 2040 non-sOb matched inclusion criteria. Compared with non-sOb, sOb group gathered all the worse conditions and risk factors: more ASA3-4 (39.3% vs. 10.2%; p < 0.001), symptomatic hernia (15.7% vs. 6.8%; p < 0.001), defect > 4 cm in diameter (24.3% vs. 8.8%; p < 0.001), emergency surgery (6.1% vs. 2.5%; p = 0.003), and Altemeir class > 1 (9.4% vs. 2.9%; p < 0.001). Laparoscopic IPOM was used more often in sOb patients (40% vs. 32%; p = 0.016), but with smaller Hauters' ratio (46 vs. 73; p < 0.001). Compared with the non-sOb, the rate of day-case surgery was lower (48% vs. 68%; p < 0.001), the surgical site occurrences were significantly more frequent (6.4 %vs. 2.5%; p < 0.001). The main outcome, 2-year recurrence, was 5.9% in the sOb vs. 2.1% (p = 0.008), and 2-year reoperations was 3% vs. 0.3% (p = 0.006). In the adjusted analysis, severe obesity was an independent risk factor for recurrence [OR = 2.82, (95%CI, 1.45; 5.22); p = 0.003]. CONCLUSION In patients with severe obesity, mPVHR is technically challenging and recurrence rate is three times higher than that of non-severely obese patients.
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Affiliation(s)
- J Turmine
- Department of General Surgery and Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- Hospices Civils de Lyon, University of Lyon I, Lyon, France
| | - A-M Florence
- Department of Epidemiology Biostatistics and Clinical Research, AP-HP Nord, Hôpital Bichat, Paris, France
- Université Paris Cité, INSERM, IAME, UMR 1137, Paris, France
| | - C Tardivon
- Department of Epidemiology Biostatistics and Clinical Research, AP-HP Nord, Hôpital Bichat, Paris, France
- Centre d'Investigations Cliniques-Epidémiologie Clinique 1425, INSERM, Hôpital Bichat, 75018, Paris, France
| | - G Passot
- Department of General Surgery and Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- Hospices Civils de Lyon, University of Lyon I, Lyon, France
- CICLY EMR 3738 Lyon Sud Charles Mérieux Faculty, Claude Bernard University Lyon 1, Oullins, France
| | - J-F Gillion
- Unité de Chirurgie Viscérale et Digestive, Ramsay Santé, Hôpital Privé d'Antony, Antony, France
| | - D Moszkowicz
- Université Paris Cité, Gastrointestinal and Metabolic Dysfunctions in Nutritional Pathologies Centre de Recherche sur l'Inflammation Paris Montmartre INSERM UMRS 1149, 75890, Paris, France.
- Service de Chirurgie Générale et Digestive, AP-HP, Hôpital Louis Mourier, DMU ESPRIT-GHU AP-HP, Nord-Université Paris Cité, 178 rue des Renouillers, 92700, Colombes, France.
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Malaussena Z, Mhaskar R, Richmond N, Diab ARF, Sujka J, DuCoin C, Docimo S. Hernia repair in the bariatric patient: a systematic review and meta-analysis. Surg Obes Relat Dis 2024; 20:184-201. [PMID: 37973424 DOI: 10.1016/j.soard.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 09/03/2023] [Accepted: 10/11/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Repair options for ventral hernias in bariatric patients include performing a staged approach in which bariatric surgery is performed before definitive hernia repair (BS-first), a staged approach in which hernia repair is performed before bariatric surgery (HR-first), or a concomitant approach. OBJECTIVES This meta-analysis aims to determine which surgical approach is best for bariatric patients with hernias. SETTING PubMed, CENTRAL, and Embase databases. METHODS A comprehensive search was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to screen for all studies that focused on outcomes of patients who underwent both hernia repair and bariatric surgery, either simultaneously or separately. Exclusion criteria included hiatal and inguinal hernia studies, case reports, and case series. RESULTS 27 studies fit our inclusion criteria after identifying 1584 studies initially. Seven comparative studies were included, enrolling 8548 staged patients (6458 BS-first) and 3528 concomitant patients. A total of 7 single-arm staged studies and 13 single-arm concomitant studies were also included. Data on hernia recurrence, mesh infection, reoperation, surgical site infections, seroma, bowel complications, and mortality were abstracted. The concomitant approach was associated with decreased odds of experiencing surgical site infections, reoperation, and seromas. The staged approach (BS-first) was associated with decreased odds of mesh infection. The single-arm studies suggest a lower incidence of hernia recurrence in a staged BS-first approach than in a concomitant approach. CONCLUSIONS The data suggest a concomitant approach is appropriate for hernias that the surgeon feels do not require mesh, while the staged (BS-first) approach is more appropriate if the hernia requires mesh placement.
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Affiliation(s)
- Zachary Malaussena
- University of South Florida Morsani College of Medicine, Tampa, Florida.
| | - Rahul Mhaskar
- University of South Florida Morsani College of Medicine, Tampa, Florida; Department of Medical Education, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Noah Richmond
- University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Abdul-Rahman F Diab
- University of South Florida Morsani College of Medicine, Tampa, Florida; Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Joseph Sujka
- University of South Florida Morsani College of Medicine, Tampa, Florida; Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Christopher DuCoin
- University of South Florida Morsani College of Medicine, Tampa, Florida; Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Salvatore Docimo
- University of South Florida Morsani College of Medicine, Tampa, Florida; Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida
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Lindmark M, Löwenmark T, Strigård K, Gunnarsson U. Ventral hernia repair with concurrent intra-abdominal surgery: Results from an eleven-year population-based cohort in Sweden. Am J Surg 2023; 226:360-364. [PMID: 37301647 DOI: 10.1016/j.amjsurg.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 05/29/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND One remaining question in ventral hernia repair is whether to perform concurrent abdominal surgery or plan two-stage procedures. The aim was to explore the risk for reoperation and mortality due to surgical complication during index admission. METHOD Eleven-year data were retrieved from the National Patient Register and 68,058 primary surgical admissions were included, divided into minor and major hernia surgery and concurrent abdominal surgery. Results were evaluated by logistic regression analysis. RESULTS The risk for reoperation during index admission was higher for patients with concurrent surgery. Major hernia surgery and major concurrent surgery had an OR 37.9 compared to major hernia surgery only. Mortality rate within 30 days increased, OR 9.32. The combined risk for serious adverse event was accumulative. CONCLUSION These results stress the importance of critically evaluating needs for and planning of concurrent abdominal surgery during ventral hernia repair. Reoperation rate was a valid and useful outcome variable.
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Affiliation(s)
- Mikael Lindmark
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Sweden.
| | - Thyra Löwenmark
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Sweden
| | - Karin Strigård
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Sweden
| | - Ulf Gunnarsson
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Sweden
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Ghanem OM, Orenstein S, Lloyd SJA, Andalib A, Race A, Burt HA, Husain F, Goldblatt M, Kroh M. Management of abdominal wall hernias in patients with severe obesity. Surg Endosc 2023; 37:6619-6626. [PMID: 37488442 DOI: 10.1007/s00464-023-10312-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 07/12/2023] [Indexed: 07/26/2023]
Abstract
Obesity is a risk factor for abdominal wall hernia development and hernia recurrence. The management of these two pathologies is complex and often entwined. Bariatric and ventral hernia surgery require careful consideration of physiologic and technical components for optimal outcomes. In this review, a multidisciplinary group of Society of American Gastrointestinal and Endoscopic Surgeons' bariatric and hernia surgeons present the various weight loss modalities available for the pre-operative optimization of patients with severe obesity and concurrent hernias. The group also details the technical aspects of managing abdominal wall defects during weight loss procedures and suggests the optimal timing of definitive hernia repair after bariatric surgery. Since level one evidence is not available on some of the topics covered by this review, expert opinion was implemented in some instances. Additional high-quality research in this area will allow for better recommendations and therefore treatment strategies for these complex patients.
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Affiliation(s)
- Omar M Ghanem
- Department of Surgery, Mayo Clinic, Rochester, MN, 55905, USA.
| | - Sean Orenstein
- Division of Gastrointestinal and General Surgery, Oregon Health and Science University, Portland, OR, USA
| | | | - Amin Andalib
- Department of Surgery, McGill University, Montreal, QC, USA
| | - Alice Race
- Department of Surgery, West Virginia University, Morgantown, WV, USA
| | - Holly Ann Burt
- Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), Los Angeles, CA, USA
| | - Farah Husain
- College of Medicine, University of Arizona, Phoenix, AZ, USA
| | - Matthew Goldblatt
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Matthew Kroh
- Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
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Robin L, Gaujoux S, Genser L. Complete MESH migration into the jejuno-jejunal anastomosis following ventral hernia repair and Roux-en-Y gastric bypass. ANZ J Surg 2023; 93:768-769. [PMID: 36048572 DOI: 10.1111/ans.18010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/15/2022] [Accepted: 08/18/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Lea Robin
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Hepato-Biliary and Pancreatic Surgery, liver transplantation, Pitié-Salpêtrière University Hospital, Paris, France
| | - Sebastien Gaujoux
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Hepato-Biliary and Pancreatic Surgery, liver transplantation, Pitié-Salpêtrière University Hospital, Paris, France
| | - Laurent Genser
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Hepato-Biliary and Pancreatic Surgery, liver transplantation, Pitié-Salpêtrière University Hospital, Paris, France
- Sorbonne Université, INSERM, Nutrition and Obesities: Systemic Approaches (NutriOMics) Research Unit, Paris, France
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Keshvedinova AA, Smirnov AV, Stankevich VR, Sharobaro VI, Ivanov YV. [Treatment of ventral hernias in patients with morbid obesity]. Khirurgiia (Mosk) 2023:95-102. [PMID: 37707338 DOI: 10.17116/hirurgia202309195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
The review is devoted to the treatment of ventral hernias in patients with morbid obesity. This issue is important due to significant number of such patients and no unambiguous clinical recommendations. The advantages of simultaneous surgery (with bariatric intervention) are obvious, i.e. lower risk of postoperative hernia incarceration and no need for re-hospitalization with another intervention. High risk of bariatric population makes it necessary to minimize surgery time and surgical trauma. A staged approach with reducing body weight surgically or conservatively before hernia repair is often chosen. Hernia repair should be performed using laparoscopic or robotic techniques with obligatory use of mesh implants. Panniculectomy or abdominoplasty as the main surgery is a valid option. Currently, it is necessary to develop clear criteria for selecting patients with morbid obesity for staged and simultaneous treatment of ventral hernias.
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Affiliation(s)
- A A Keshvedinova
- Federal Research and Clinical Center for Specialized Types of Medical Care and Medical Technologies, Moscow, Russia
| | - A V Smirnov
- Federal Research and Clinical Center for Specialized Types of Medical Care and Medical Technologies, Moscow, Russia
| | - V R Stankevich
- Federal Research and Clinical Center for Specialized Types of Medical Care and Medical Technologies, Moscow, Russia
| | - V I Sharobaro
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - Yu V Ivanov
- Federal Research and Clinical Center for Specialized Types of Medical Care and Medical Technologies, Moscow, Russia
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
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