Reducing the Incidence of Incisional Hernias following Open Gastric Bypass Surgery

Abstract

A reduction in incision size, the avoidance of the periumbilical region and the use of nonabsorbable sutures has significantly reduced the incidence of incisional hernias and acute fascial disruptions with our form of open RYGBP. These findings are consistent with LaPlace's law regarding wall tension and vessel radius. In addition, we found smaller incisions to be associated with fewer infections and seromas and less postoperative discomfort. A reduction in incision size has not been associated with an increase in morbidity or mortality or changes in the operative time.

Incisional Hernia Prophylaxis in Morbidly Obese Patients Undergoing Biliopancreatic Diversion

“…However, laparoscopic BPD is characterized by a similar incidence of postoperative complication such as bowel obstruction, gastrointestinal hemorrhage, anastomotic leakage, and stomal stenosis [4][5][6]. Consequently, the open approach is still the preferred technique for many surgeons around the world [4][5][6]. Unfortunately, as stated before, the incidence of incisional hernia in open bariatric surgery has been reported to be high as 25%, reaching 50% in superobese patients [1,2].…”

“…In the last decade, laparoscopy has been widely utilized in bariatric surgery especially because it reduces the incidence of incisional hernia [13]. However, laparoscopic BPD is characterized by a similar incidence of postoperative complication such as bowel obstruction, gastrointestinal hemorrhage, anastomotic leakage, and stomal stenosis [4][5][6]. Consequently, the open approach is still the preferred technique for many surgeons around the world [4][5][6].…”

“…Laparoscopic bariatric surgery has significantly reduced the risk of incisional hernias. However, the long learning curve and a similar, if not increased, incidence of complications such as bowel obstruction, gastrointestinal hemorrhage, and stomal stenosis associated with laparoscopy make the open approach the preferred technique for many surgeons [4][5][6]. The development of incisional hernia after open abdominal surgery is a major cause of postoperative morbidity and hospital readmission.…”

Long-term Outcome with the Prophylactic Use of Polypropylene Mesh in Morbidly Obese Patients Undergoing Biliopancreatic Diversion

“…Their incidence varies between 2% and 13% in different series but may reach up to 45% in high-risk patients as the morbidly obese ones [1]. The development of hernia is the major cause of morbidity after open bariatric surgery.…”

Primary mesh augmentation with fibrin glue for abdominal wall closure—investigations on a biomechanical model

“…Apparently, even the surgeon can exert a pronounced influence on the incidence of incisional hernias. For example, smaller incisions in risk groups, such as in obese patients, are thought to significantly reduce the occurrence of incisional hernias [17]. Transverse or oblique incisions, whenever possible, are also believed to reduce the incidence of incisional hernias [1,18].…”