A Multidisciplinary Approach to Medical Weight Loss Prior to Complex Abdominal Wall Reconstruction: Is it Feasible?

Rosen, Michael J.; Aydogdu, Kasim; Grafmiller, Kevin; Petro, Clayton C.; Faiman, Gregg H.; Prabhu, Ajita S.

doi:10.1007/s11605-015-2856-6

Cited by 73 publications

(55 citation statements)

References 28 publications

(27 reference statements)

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“…A recent study demonstrated that medically supervised weight loss prior to AWR can significantly reduce postoperative complications among morbidly obese patients and it can be considered a possible additional strategy to minimize SSO. [7] In contrast, non-surgical weight loss before AWR can lead to a delay of the AWR procedure. [7, 39] Nonetheless, the effects of preoperative weight loss on AWR outcomes, particularly hernia recurrence, are still not clear, and further research on this topic is warranted.…”

Section: Discussionmentioning

confidence: 99%

“…[7] In contrast, non-surgical weight loss before AWR can lead to a delay of the AWR procedure. [7, 39] Nonetheless, the effects of preoperative weight loss on AWR outcomes, particularly hernia recurrence, are still not clear, and further research on this topic is warranted. [39]…”

Section: Discussionmentioning

confidence: 99%

“…[41, 42] Given the possible additional wound healing risk, panniculectomy can also be performed with drain placement to minimize seroma formation in selected patients. [7, 20, 43, 44]…”

Section: Discussionmentioning

confidence: 99%

“…[3] Recent studies suggest that obesity increases the rates of complications after AWR, and elevated BMI is associated with rates of wound healing complications and hernia recurrence up to 48.7% and 41.7%, respectively, after AWR. [6, 7, 8] Further complicating this issue, over 54% of Americans have a centralized abdominal distribution of subcutaneous fat, or “abdominal obesity.” [3]…”

Section: Introductionmentioning

confidence: 99%

“…[9, 10] However, to date, only a few studies have compared AWR outcomes in obese and non-obese patients, and the data available are confounded by significant heterogeneity within cohorts, particularly regarding the type of the study population, the abdominal hernia/defect size and short duration of follow-up. [7, 11–14]…”

Section: Introductionmentioning

confidence: 99%

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The Impact of Body Mass Index on Abdominal Wall Reconstruction Outcomes: A Comparative Study

Giordano

Garvey

Baumann

et al. 2017

Plastic &Amp; Reconstructive Surgery

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Background Obesity and higher body mass index (BMI) may be associated with higher rates of wound healing complications and hernia recurrence rates following complex abdominal wall reconstruction (AWR). We hypothesized that higher BMI’s result in higher rates of postoperative wound healing complications but similar rates of hernia recurrence in AWR patients. Methods We included 511 consecutive patients who underwent AWR with underlay mesh. Patients were divided into three groups on the basis of preoperative BMI: <30 kg/m2 (non-obese), 30–34.9 kg/m2 (class I obesity) and ≥35 kg/m2 (class II/III obesity). We compared postoperative outcomes among these three groups. Results Class I and class II/III obesity patients had higher surgical site occurrence rates than non-obese patients (26.4% vs. 14.9%; p=0.006 and 36.8% vs. 14.9%; p<0.001, respectively) and higher overall complication rates (37.9% vs. 24.7%; p=0.007 and 43.4% vs. 24.7%; p<0.001, respectively). Similarly, obese patients had significantly higher skin dehiscence (19.3% vs 7.2%; p<0.001 and 26.5% vs 7.2%; p<0.001, respectively) and fat necrosis rates (10.0% vs 2.1%; p=0.001 and 11.8% vs 2.1%; p<0.001, respectively) than non-obese patients. Obesity class II/III patients had higher infection and seroma rates than non-obese patients (9.6% vs 4.3%; p=0.041 and 8.1% vs 2.1%; p=0.006, respectively). However, class I and class II/III obesity patients experienced hernia recurrence rates (11.4% vs. 7.7%; p=0.204 and 10.3% vs. 7.7%; p=0.381, respectively) and freedom from hernia recurrence (overall log-rank p=0.41) similar to non-obese patients. Conclusions Hernia recurrence rates do not appear to be affected by obesity on long-term follow-up in AWR.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…[41, 42] Given the possible additional wound healing risk, panniculectomy can also be performed with drain placement to minimize seroma formation in selected patients. [7, 20, 43, 44]…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Impact of Body Mass Index on Abdominal Wall Reconstruction Outcomes: A Comparative Study

Giordano

Garvey

Baumann

et al. 2017

Plastic &Amp; Reconstructive Surgery

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Costs Associated With Modifiable Risk Factors in Ventral and Incisional Hernia Repair

et al. 2019

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Year-Over-Year Ventral Hernia Recurrence Rates and Risk Factors

Bhardwaj,

Huayllani,

Olson

et al. 2024

JAMA Surg

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ImportanceRecurrence is one of the most challenging adverse events after ventral hernia repair as it impacts quality of life, utilization of resources, and subsequent need for re-repair. Rates of recurrence range from 30% to 80% after ventral hernia repair.ObjectiveTo determine the contemporary ventral hernia recurrence rate over time in patients with previous hernia repair and to determine risk factors associated with recurrence.Design, Setting, and ParticipantsThis retrospective, population-based study used the Abdominal Core Health Quality Collaborative registry to evaluate year-over-year recurrence rates in patients with prior ventral hernia repair between January 2012 and August 2022. Patients who underwent at least 1 prior ventral hernia repair were included and categorized into 2 groups based on mesh or no-mesh use. There were 43 960 eligible patients; after exclusion criteria (patients with concurrent inguinal hernias as the primary diagnosis, nonstandard hernia procedure categories, American Society of Anesthesiologists class unassigned, or no follow-up), 29 834 patients were analyzed in the mesh group and 5599 in the no-mesh group.Main Outcomes and MeasuresVentral hernia recurrence rates. Risk factors analyzed include age, body mass index, sex, race, insurance type, medical comorbidities, American Society of Anesthesiologists class, smoking, indication for surgery, concomitant procedure, hernia procedure type, myofascial release, fascial closure, fixation type, number of prior repairs, hernia width, hernia length, mesh width, mesh length, operative approach, prior mesh placement, prior mesh infection, mesh location, mesh type, postoperative surgical site occurrence, postoperative surgical site infection, postoperative seroma, use of drains, and reoperation.ResultsAmong 29 834 patients with mesh, the mean (SD) age was 57.17 (13.36) years, and 14 331 participants (48.0%) were female. Among 5599 patients without mesh, the mean (SD) age was 51.9 (15.31) years, and 2458 participants (43.9%) were female. When comparing year-over-year hernia recurrence rates in patients with and without prior mesh repair, respectively, the Kaplan Meier analysis showed a recurrence rate of 201 cumulative events with 13 872 at risk (2.8%) vs 104 cumulative events with 1707 at risk (4.0%) at 6 months; 411 cumulative events with 4732 at risk (8.0%) vs 184 cumulative events with 427 at risk (32.6%) at 1 year; 640 cumulative events with 1518 at risk (19.7%) vs 243 cumulative events with 146 at risk (52.4%) at 2 years; 731 cumulative events with 670 at risk (29.3%) vs 258 cumulative events with 73 at risk (61.4%) at 3 years; 777 cumulative events with 337 at risk (38.5%) vs 267 cumulative events with 29 at risk (71.2%) at 4 years; and 798 cumulative events with 171 at risk (44.9%) vs 269 cumulative events with 19 at risk (73.7%) at 5 years. Higher body mass index; immunosuppressants; incisional and parastomal hernias; a robotic approach; greater hernia width; use of a biologic or resorbable synthetic mesh; and complications, such as surgical site infections and reoperation, were associated with higher odds of hernia recurrence. Conversely, greater mesh width, myofascial release, and fascial closure had lower odds of recurrence. Hernia type was the most important variable associated with recurrence.Conclusions and RelevanceIn this study, the 5-year recurrence rate after ventral hernia repair was greater than 40% and 70% in patients with and without mesh, respectively. Rates of ventral hernia recurrence increased over time, underscoring the importance of close, long-term follow up in this population.

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A Multidisciplinary Approach to Medical Weight Loss Prior to Complex Abdominal Wall Reconstruction: Is it Feasible?

Cited by 73 publications

References 28 publications

The Impact of Body Mass Index on Abdominal Wall Reconstruction Outcomes: A Comparative Study

The Impact of Body Mass Index on Abdominal Wall Reconstruction Outcomes: A Comparative Study

Costs Associated With Modifiable Risk Factors in Ventral and Incisional Hernia Repair

Year-Over-Year Ventral Hernia Recurrence Rates and Risk Factors

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