Laparoscopic Ventral Hernia Repair in Bariatric Patients: the Role of Defect Size and Deferred Repair

Olmi, Stefano; Uccelli, Matteo; Cesana, Giovanni; Ciccarese, Francesca; Oldani, Alberto; Giorgi, Riccardo; Carli, Stefano Maria De; Villa, Roberta; Zanoni, Adelinda; Ismail, Ayman

doi:10.1007/s11695-020-04747-2

Cited by 14 publications

(18 citation statements)

References 17 publications

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“…The jury is out on what might be the best approach to obese patients presenting with other diagnoses, such as uncomplicated hernia, 2 and the options range from both simultaneously to bariatric surgery first, and subsequent hernia repair after weight loss or hernia repair followed by bariatric surgery at a later point in time. 3 But there is no real consensus in the asymptomatic group of patients, let alone in those presenting with complications in the hernia, or other emergent inflammatory or neoplastic diagnoses. 4 There is also no consensus regarding the hernia size or the extent of domain loss that might preclude combining a bariatric procedure with it.…”

Section: Discussionmentioning

confidence: 99%

Can Classical Roux-N-Y Gastric Bypass Be Combined with Surgical Emergencies? An Interesting Case Series with Literature Review of Two Patients at a Tertiary Care Center

Mohanty¹

2022

International Journal of Recent Surgical and Medical Sciences

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Weight-loss surgery is usually recommended to those who walk into our specialist bariatric outpatient department, and intense and often exhaustive counseling, along with a thorough preoperative workup, is undertaken prior to the surgery. All this often fails in the emergent scenario, where the focus shifts to a damage-control mode, and the possibility of a metabolic procedure in this setting, especially one as challenging as gastric bypass, is seldom actively pursued. We discuss two patients presenting to the emergency department with different surgical ailments, but also being obese, with comorbidities, finally undergoing the primary surgeries along with Roux-N-Y gastric bypass, via conventional and laparoscopic methods respectively, with positive immediate outcomes and favorable 1-year excess-body-weight-loss as well. This shows that if patient selection is wise, and adequate expertise is available, gastric bypass can be offered in the emergent scenario as well, with favorable outcomes.

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Section: Discussionmentioning

confidence: 99%

Can Classical Roux-N-Y Gastric Bypass Be Combined with Surgical Emergencies? An Interesting Case Series with Literature Review of Two Patients at a Tertiary Care Center

Mohanty¹

2022

International Journal of Recent Surgical and Medical Sciences

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“…Unfortunately, laparoscopic VHR is not a correct indication for CVH with LoD. Actually, some authors recommend a two-stage surgical approach [1,9], which would entail an open SG with a bridge abdominal wall repair and delayed definitive VHR. In our patient, the relevant LoD would have not allowed a safe laparoscopic SG and a two-stage approach was excluded due to the major severity of CVH.…”

Section: Discussionmentioning

confidence: 99%

Synchronous Surgical Treatment of Morbid Obesity and Complex Ventral Hernia After Progressive Pneumoperitoneum and Botulinum Toxin A Injection

et al. 2021

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Introduction The worldwide increase in morbidly obese patients with complex hernia raises controversies in the choice of the appropriate treatment timing: synchronous bariatric and abdominal wall surgery versus delayed abdominal wall surgery. We report an innovative tailored surgical treatment carried out at our Institution. Patient and Methods The approach provided the injection, 6 weeks before surgery, of 500 IU of botulinum toxin A on either side of the large abdominal wall muscles. Four weeks before surgery, pneumoperitoneum was inducted and out-patient daily sessions of progressive insufflation with ambient air were then carried out. Surgery was scheduled 48 days after botulinum injection. Sleeve gastrectomy and simultaneous posterior component separation with transversus abdominis release were performed. Two prosthetic meshes were placed sublay. Postoperative superficial surgical site infection was successfully treated with negative pressure wound therapy. At a 1-year follow-up, no hernia recurrence was recorded while total body weight loss was 31%. Discussion A delay in ventral hernia repair could worsen the quality of life of morbidly obese patients. In such high-risk patients, the choice of the best surgical strategy remains controversial. There is great concern in performing bariatric surgery simultaneously to hernia repair, although there is lack of evidence on which is the ideal treatment modality. Conclusion Synchronous bariatric surgery and complex ventral hernia repair should be approached in high-volume centres where a consolidated experience of multidisciplinary teamwork is available. Combined botulinum toxin A and preoperative progressive pneumoperitoneum administration allow for a safe resolution of loss of domain.

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“…Therefore, if there is vascularized greater omentum in the hernia gap, it should not be removed. If hernia contents are reduced during bariatric surgery, it is recommended to close the gap, either with suture (orifices <2 cm) or mesh [12, 14]. Hernia repair after bariatric operation should be postponed until the catabolic phase of weight loss is over.…”

Section: Bariatric Surgery Before Hernia Repairmentioning

confidence: 99%

Excess Body Weight and Abdominal Hernia

Dietz¹,

Kudsi²,

Gökçal³

et al. 2021

Visc Med

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Background: Obese patients have an increased incidence of ventral hernias; in over 50% of these cases, patients are symptomatic. At the same time, morbid obesity is a disease of epidemic proportions. The combination of symptomatic hernia and obesity is a challenge for the treating surgeon, because the risk of perioperative complications and recurrence increases with increasing BMI. Summary: This review outlines this problem and discusses interdisciplinary approaches to the management of affected patients. In emergency cases, the hernia is treated according to the surgeon’s expertise. In elective cases, an individual decision must be made whether bariatric surgery is indicated before hernia repair or whether both should be performed simultaneously. After bariatric surgery a weight reduction of 25–30% of total body weight in the first year can be achieved and it is often advantageous to perform a bariatric operation prior to hernia repair. Technically, the risk of complications is lower with minimally invasive procedures than with open ones, but laparoscopy is challenging in obese patients, and meshes can only be implanted in intraperitoneal position. This mesh position has to be questioned because of adhesions, recurrence rate, and risk of contamination during re-interventions in patients who are often still relatively young. Key Messages: Obese patients with hernia need to be approached in an interdisciplinary manner, in some patients a weight loss procedure may be advantageous before hernia repair. Recent data show the benefits of robotic hernia surgery in obese patients, as not only haptic advantages result, but especially the mesh can be implanted in a variety of extraperitoneal positions in the abdominal wall with low morbidity.

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Laparoscopic Ventral Hernia Repair in Bariatric Patients: the Role of Defect Size and Deferred Repair

Cited by 14 publications

References 17 publications

Can Classical Roux-N-Y Gastric Bypass Be Combined with Surgical Emergencies? An Interesting Case Series with Literature Review of Two Patients at a Tertiary Care Center

Can Classical Roux-N-Y Gastric Bypass Be Combined with Surgical Emergencies? An Interesting Case Series with Literature Review of Two Patients at a Tertiary Care Center

Synchronous Surgical Treatment of Morbid Obesity and Complex Ventral Hernia After Progressive Pneumoperitoneum and Botulinum Toxin A Injection

Excess Body Weight and Abdominal Hernia

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