Patient Selection Optimization following Combined Abdominal Procedures

Koolen, Pieter G. L.; Ibrahim, Ahmed M. S.; Kim, Kuylhee; Sinno, Hani; Lee, Bernard T.; Schneider, Benjamin E.; Jones, Daniel B.; Lin, Samuel J.

doi:10.1097/prs.0000000000000519

Cited by 64 publications

(16 citation statements)

References 44 publications

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“…Thus, there is a consensus on higher complication rates after VHR in morbidly obese patients, BMI≥40; however, our analysis indicates that obese patients (BMI≥30) undergoing VHR have an OR of 2.13 (95% CI 1.24 to 3.67, p=0.01) of postoperative complications [8,18]. The mechanisms underlying the increased complication rate in obese patients are likely multifactorial, but hypotheses exist that may explain the predisposition for complications in obese and hypertensive patients [10]. Impaired visualization due to body habitus in addition to defects in tissue structure and healing are likely contributors to postoperative complications after VHRs in obese patients [19].…”

Section: Discussionmentioning

confidence: 60%

“…Certain comorbidities such as obesity, smoking history, and diabetes mellitus have also been associated with increased complications [8,9]. Preexisting hypertension is associated with increased rates of complications in abdominal surgical procedures overall; however, there is a lack of evidence on hypertension as a risk factor in hernia repairs, specifically [10].…”

Section: Introductionmentioning

confidence: 99%

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Long-Term Outcomes of Ventral Hernia Repair: An 11-Year Follow-Up

Kadakia

Mudgway

et al. 2020

Cureus

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Background: Ventral hernia repair (VHR) is one of the most common general surgery procedures; however, few studies with long-term follow-up of VHR outcomes exist. Methods: We performed a retrospective review of VHRs performed from 2000 to 2009 at a single institution. Our primary outcome was recurrence, and secondary outcomes were reoperations and complications including seroma, hematomas, abdominal wall abscess, wound infections, and mesh infections. Results: Our sample population (n=420; mean age 46.3±11.7 years) included 230 females (54.8%), and cases included laparoscopic (n=31; 7.5%), laparoscopic converted to open (n=7; 1.7%), and open (n=373, 90%). As compared to suture repairs, mesh repair was associated with lower rates of complications (25.7% vs 29.5%, p=0.10) and recurrence (12.8% vs 15.2%, p=0.67). Laparoscopic repairs had lower rates of complications than open repairs (25% vs 26.8%; p=0.70) but similar rates of recurrence (13.8% and 13.6%; p=0.53). After logistic regression, obesity, chronic obstructive pulmonary disease, component separation technique, and prolonged operating time (>75th percentile) were associated with increased complications. Conclusion: Obesity is a modifiable risk factor and must be addressed in patients undergoing VHRs. Mesh repair does not increase the risk of adverse long-term outcomes and may be performed safely in patients undergoing VHR.

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Section: Discussionmentioning

confidence: 60%

Section: Introductionmentioning

confidence: 99%

Long-Term Outcomes of Ventral Hernia Repair: An 11-Year Follow-Up

Kadakia

Mudgway

et al. 2020

Cureus

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“…Bariatric surgery is a commonly performed highly effective treatment in achieving long-term weight loss and resolution of obesity-related comorbidities. However, in the majority of these patients body contour irregularities and postoperative hernias (in 10–50%) form after open bariatric procedures [1–5]. Skin redundancy at different body parts observed in more than two-thirds of patients after major weight loss, in some cases with malpositioned adipose tissue, are responsible for hygiene problems, persistent inflammatory changes inside skin folds and both for physical and psychosocial discomfort for the patients.…”

Section: Introductionmentioning

confidence: 99%

“…Given the excellent intraoperative exposure of the abdominal wall during abdominal contouring surgery, concurrent ventral, umbilical, or inguinal hernia repair is also often performed. Despite generally higher risk of complications (seroma formation, wound infection) following simultaneous abdominal wall surgery, most of the authors reported favorable outcomes of abdominoplasty combined with hernia repair [1, 3, 13, 16]. Complex body contouring surgery in postbariatric groups after massive weight loss has been discussed regarding postoperative results and patients’ life quality, however, there are no reports on long-term observations comparing abdominoplasty along with incisional hernia repair (IHR) performed using two separate techniques.…”

Section: Introductionmentioning

confidence: 99%

Sublay or onlay incisional hernia repair along with abdominoplasty: which is better? Long-term results

Iljin

Antoszewski

Zieliński

et al. 2019

Hernia

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Purpose Estimation and comparison of results after incisional hernia repair (IHR) modo onlay or sublay with abdominoplasty in patients who lost the weight following Roux-en-Y Gastric Bypass (RYGB). Analysis and comparison of changes in quality of life (QL) of these patients prior to RYGB, before and after simultaneous IHR and abdominoplasty. Methods Clinical analysis involved 40 patients with abdominal disfigurement (following RYGB and massive weight loss) after one-time IHR sublay method with abdominoplasty—group 1 or IHR onlay method with abdominoplasty—group 2. We evaluated postoperative results and long-term QL changes (DAS24, SF-36 scales). Results We noted abnormal wound healing (2), pneumonia (3) and dysesthesia (3) in patients from group 1, and abnormal wound healing (2), seroma (2), pneumonia (2), and dysesthesia (4) in group 2. Quality of life was improved in the functional, esthetic and psychological aspects. Conclusions One stage incisional hernia repair by onlay as well as sublay method with abdominoplasty are safe surgical methods improving the functioning of patients after major weight loss following RYGB. Sublay hernia repair and abdominoplasty was connected with longer time of the: operation, drainage, analgesic agents use, time to mobilization and to full oral diet than the onlay method. Significant improvement of the quality of life was noted after every subsequent step of surgical treatment in both groups. Reduction of the risk of BMI re-growth after bariatric surgery is related to the need for constant, specialized care for these patients at every stage of follow-up after bariatric surgery.

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“…Uma análise de 4925 pacientes submetidos à abdominoplastia com ou sem hernioplastia concomitante evidenciou que os procedimentos combinados apresentavam maiores complicações em relação ao procedimento único. Hipertensão, tabagismo e uso crônico de esteroides foram identificados como preditores de complicações, e o grupo com a cirurgia combinada (abdominoplastia associada à hernioplastia) teve maior taxa de complicações (18,3% versus 9,8%) 4 .…”

Section: Discussionunclassified