Body Mass Index Effect on Minimally Invasive Ventral Hernia Repair: A Systematic Review and Meta-analysis

Abstract

Purpose: Obesity is one of the most important risk factors for complications after ventral hernia repair (VHR), and minimally invasive (MIS) techniques are preferred in obese patients as they minimize wound complications. It is common practice to attempt weight loss to achieve a specific body mass index (BMI) goal; however, patients are often unable to reach it and fail to become surgical candidates. Therefore, we aim to perform a meta-analysis of studies comparing outcomes of obese and nonobese patients undergoing laparoscopic or robotic VHR. Patients and Methods: A literature search of PubMed, Scopus, and Cochrane Library databases was performed to identify studies comparing obese and nonobese patients undergoing MIS VHR. Postoperative outcomes were assessed by means of pooled analysis and meta-analysis. Statistical analysis was performed using RevMan 5.4. Heterogeneity was assessed with I 2 statistics. Results: A total of 6483 studies were screened and 26 were thoroughly reviewed. Eleven studies and 3199 patients were included in the meta-analysis. BMI >40 kg/m2 cutoff analysis included 5 studies and 1533 patients; no differences in hernia recurrence [odds ratios (OR): 1.64; 95% CI: 0.57-4.68; P = 0.36; I 2 = 47%), seroma, hematoma, and surgical site infection (SSI) rates were noted. BMI >35 kg/m2 cutoff analysis included 5 studies and 1403 patients; no differences in hernia recurrence (OR: 1.24; 95% CI: 0.71-2.16; P = 0.58; I 2 = 0%), seroma, hematoma, and SSI rates were noted. BMI >30 kg/m2 cutoff analysis included 4 studies and 385 patients; no differences in hernia recurrence (OR: 2.07; 95% CI: 0.5-8.54; P = 0.32; I 2 = 0%), seroma, hematoma, and SSI rates were noted. Conclusion: Patients with high BMI undergoing MIS VHR have similar hernia recurrence, seroma, hematoma, and SSI rates compared with patients with lower BMI. Further prospective studies with long-term follow-up and patient-reported outcomes are required to establish optimal management in obese patients undergoing VHR.

Effect of Obesity on Surgical Outcomes and Complication Rates in Pediatric Patients: A Comprehensive Systematic Review and Meta-Analysis

“…Patients who were underweight or overweight were not considered. The primary outcomes evaluated were surgical wound dehiscence, surgical site infection (SSI), including superficial and deep wounds, bleeding that required transfusion, deep venous thromboembolism (DVT), and postoperative abscess formation as defined by individual studies [ 14 , 15 ]. These outcomes were selected as they are the most commonly studied in different meta-analyses that evaluate the effect of obesity on surgical outcomes within the adult population.…”

“…Similarly, Liu et al reported that BMI ≥30 kg/m 2 resulted in significantly higher SSI after colorectal surgery [ 42 ]. However, some other studies in adult populations have found no difference based on BMI for SSI, such as in the case of inguinal hernia repair [ 14 ]. In our study, encompassing different types of surgery, we found that obese pediatric patients had a 1.63 times higher risk of developing an SSI compared to normal-weight patients.…”