Concurrent minimally invasive bariatric surgery and ventral hernia repair with mesh; Is it safe? Propensity score matching analysis using the 2015-2022 MBSAQIP database.
Bariatric surgery
Gastric bypass
Minimally invasive surgery
Sleeve gastrectomy
Ventral hernia
Journal
Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653
Informations de publication
Date de publication:
17 Sep 2024
17 Sep 2024
Historique:
received:
20
04
2024
accepted:
31
08
2024
medline:
18
9
2024
pubmed:
18
9
2024
entrez:
17
9
2024
Statut:
aheadofprint
Résumé
Obesity is a risk factor for the development of ventral hernias. Approximately eight percent of patients undergoing bariatric surgery have a concomitant ventral hernia. However, the optimal timing of hernia repair in these patients is debated. Concerns regarding mesh insertion in a potentially contaminated field are often cited by opponents of a combined approach. Our study compares 30-day outcomes of bariatric surgery with concurrent ventral hernia repair with mesh versus bariatric surgery alone. Using the 2015-2022 MBSAQIP database, patients aged 18-65 years who underwent minimally invasive sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) with or without concurrent ventral hernia repair with mesh (VHR-M) were identified. 30-day postoperative outcomes were compared between patients who underwent SG or RYGB with VHR-M versus SG or RYGB alone. 1:1 propensity score matching was performed using 26 preoperative characteristics to adjust confounders. Among 1,236,644 patients who underwent SG (n = 871,326) or RYGB (n = 365,318), 3,121 underwent SG + VHR-M and 2,321 RYGB + VHR-M. The concurrent approach had longer operative times, in SG + VHR-M (86.06 ± 42.78 vs. 73.80 ± 38.45 min, p < 0.001), and in RYGB + VHR-M (141.91 ± 58.68 vs. 128.47 ± 62.37 min, p < 0.001). The RYGB + VHR-M cohort had higher rates of reoperations (3.2% vs. 2.1%, p = 0.024). Overall, 30-day outcomes, and bariatric-specific complications such as mortality, unplanned ICU admissions, surgical site complications, cardiac, pulmonary, renal complications, anastomotic leaks, postoperative bleeding, and intestinal obstruction were similar between SG + VHR-M or RYGB + VHR-M groups versus SG or RYGB alone. Bariatric surgery performed concurrently with VHR-M is safe and feasible and does not excessively prolong operative times. However, patients undergoing RYGB with VHR-M do have a higher rate of reoperations, therefore a staged VHR is recommended. On the other hand, concurrent SG and VHR-M may benefit after an appropriate individualized risk stratification assessment.
Sections du résumé
BACKGROUND
BACKGROUND
Obesity is a risk factor for the development of ventral hernias. Approximately eight percent of patients undergoing bariatric surgery have a concomitant ventral hernia. However, the optimal timing of hernia repair in these patients is debated. Concerns regarding mesh insertion in a potentially contaminated field are often cited by opponents of a combined approach. Our study compares 30-day outcomes of bariatric surgery with concurrent ventral hernia repair with mesh versus bariatric surgery alone.
METHODS
METHODS
Using the 2015-2022 MBSAQIP database, patients aged 18-65 years who underwent minimally invasive sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) with or without concurrent ventral hernia repair with mesh (VHR-M) were identified. 30-day postoperative outcomes were compared between patients who underwent SG or RYGB with VHR-M versus SG or RYGB alone. 1:1 propensity score matching was performed using 26 preoperative characteristics to adjust confounders.
RESULTS
RESULTS
Among 1,236,644 patients who underwent SG (n = 871,326) or RYGB (n = 365,318), 3,121 underwent SG + VHR-M and 2,321 RYGB + VHR-M. The concurrent approach had longer operative times, in SG + VHR-M (86.06 ± 42.78 vs. 73.80 ± 38.45 min, p < 0.001), and in RYGB + VHR-M (141.91 ± 58.68 vs. 128.47 ± 62.37 min, p < 0.001). The RYGB + VHR-M cohort had higher rates of reoperations (3.2% vs. 2.1%, p = 0.024). Overall, 30-day outcomes, and bariatric-specific complications such as mortality, unplanned ICU admissions, surgical site complications, cardiac, pulmonary, renal complications, anastomotic leaks, postoperative bleeding, and intestinal obstruction were similar between SG + VHR-M or RYGB + VHR-M groups versus SG or RYGB alone.
CONCLUSION
CONCLUSIONS
Bariatric surgery performed concurrently with VHR-M is safe and feasible and does not excessively prolong operative times. However, patients undergoing RYGB with VHR-M do have a higher rate of reoperations, therefore a staged VHR is recommended. On the other hand, concurrent SG and VHR-M may benefit after an appropriate individualized risk stratification assessment.
Identifiants
pubmed: 39289227
doi: 10.1007/s00464-024-11260-5
pii: 10.1007/s00464-024-11260-5
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Références
Varela JE, Hinojosa M, Nguyen N (2009) Correlations between intra-abdominal pressure and obesity-related co-morbidities. Surg Obes Relat Dis 5:524–528. https://doi.org/10.1016/j.soard.2009.04.003
doi: 10.1016/j.soard.2009.04.003
pubmed: 19560978
Israelsson LA, Jonsson T (1997) Overweight and healing of midline incisions: the importance of suture technique. Eur J Surg 163:175–180
pubmed: 9085058
Sugerman HJ, Kellum JM, Reines HD, DeMaria EJ, Newsome HH, Lowry JW (1996) Greater risk of incisional hernia with morbidly obese than steroid-dependent patients and low recurrence with prefascial polypropylene mesh. Am J Surg 171:80–84. https://doi.org/10.1016/S0002-9610(99)80078-6
doi: 10.1016/S0002-9610(99)80078-6
pubmed: 8554156
Sait MS, Som R, Borg CM, Chang A, Ramar S (2016) Best evidence topic: Should ventral hernia repair be performed at the same time as bariatric surgery? Ann Med Surg (Lond) 11:21–25. https://doi.org/10.1016/j.amsu.2016.08.014
doi: 10.1016/j.amsu.2016.08.014
pubmed: 27642515
Datta T, Eid G, Nahmias N, Dallal RM (2008) Management of ventral hernias during laparoscopic gastric bypass. Surg Obes Relat Dis 4:754–757. https://doi.org/10.1016/j.soard.2008.03.246
doi: 10.1016/j.soard.2008.03.246
pubmed: 18514585
Sauerland S, Korenkov M, Kleinen T, Arndt M, Paul A (2004) Obesity is a risk factor for recurrence after incisional hernia repair. Hernia 8:42–46. https://doi.org/10.1007/s10029-003-0161-x
doi: 10.1007/s10029-003-0161-x
pubmed: 13680307
Kaoutzanis C, Leichtle SW, Mouawad NJ, Welch KB, Lampman RM, Wahl WL, Cleary RK (2015) Risk factors for postoperative wound infections and prolonged hospitalization after ventral/incisional hernia repair. Hernia 19:113–123. https://doi.org/10.1007/s10029-013-1155-y
doi: 10.1007/s10029-013-1155-y
pubmed: 24030572
Eid GM, Mattar SG, Hamad G, Cottam DR, Lord JL, Watson A, Dallal RM, Schauer PR (2004) Repair of ventral hernias in morbidly obese patients undergoing laparoscopic gastric bypass should not be deferred. Surg Endosc 18:207–210. https://doi.org/10.1007/s00464-003-8915-1
doi: 10.1007/s00464-003-8915-1
pubmed: 14691700
Moolla M, Dang J, Modasi A, Byrns S, Switzer N, Birch DW, Karmali S (2020) Concurrent laparoscopic ventral hernia repair with bariatric surgery: a propensity-matched analysis. J Gastrointest Surg 24:58–66. https://doi.org/10.1007/s11605-019-04291-0
doi: 10.1007/s11605-019-04291-0
pubmed: 31243713
Khorgami Z, Haskins IN, Aminian A, Andalib A, Rosen MJ, Brethauer SA, Schauer PR (2017) Concurrent ventral hernia repair in patients undergoing laparoscopic bariatric surgery: a case-matched study using the National Surgical Quality Improvement Program Database. Surg Obes Relat Dis 13:997–1002. https://doi.org/10.1016/j.soard.2017.01.007
doi: 10.1016/j.soard.2017.01.007
pubmed: 28274707
Spaniolas K, Kasten KR, Mozer AB, Sippey ME, Chapman WHH, Pories WJ, Pender JR (2015) Synchronous ventral hernia repair in patients undergoing bariatric surgery. Obes Surg 25:1864–1868. https://doi.org/10.1007/s11695-015-1625-7
doi: 10.1007/s11695-015-1625-7
pubmed: 25702143
Lazzati A, Bechet S, Jouma S, Paolino L, Jung C (2020) Revision surgery after sleeve gastrectomy: a nationwide study with 10 years of follow-up. Surg Obes Relat Dis 16:1497–1504. https://doi.org/10.1016/j.soard.2020.05.021
doi: 10.1016/j.soard.2020.05.021
pubmed: 32636173
Haskins IN, Amdur RL, Lin PP, Vaziri K (2016) The use of mesh in emergent ventral hernia repair: Effects on early patient morbidity and mortality. J Gastrointest Surg 20:1899–1903. https://doi.org/10.1007/s11605-016-3207-y
doi: 10.1007/s11605-016-3207-y
pubmed: 27456013
Schuster R, Curet MJ, Alami RS, Morton JM, Wren SM, Safadi BY (2006) Concurrent gastric bypass and repair of anterior abdominal wall hernias. Obes Surg 16:1205–1208. https://doi.org/10.1381/096089206778392374
doi: 10.1381/096089206778392374
pubmed: 16989705
Thoemmes FJ, Kim ES (2011) A systematic review of propensity score methods in the social sciences. Multivar Behav Res 46:90–118. https://doi.org/10.1080/00273171.2011.540475
doi: 10.1080/00273171.2011.540475
Williams MD, Champion JK (2004) Experience with routine intraabdominal cultures during laparoscopic gastric bypass with implications for antibiotic prophylaxis. Surg Endosc 18:755–756. https://doi.org/10.1007/s00464-003-8198-6
doi: 10.1007/s00464-003-8198-6
pubmed: 14752648
Cozacov Y, Szomstein S, Safdie FM, Lo Menzo E, Rosenthal R (2014) Is the use of prosthetic mesh recommended in severely obese patients undergoing concomitant abdominal wall hernia repair and sleeve gastrectomy? J Am Coll Surg 218:358–362. https://doi.org/10.1016/j.jamcollsurg.2013.12.008
doi: 10.1016/j.jamcollsurg.2013.12.008
pubmed: 24559950
Lomanto D, Iyer SG, Shabbir A, Cheah W-K (2006) Laparoscopic versus open ventral hernia mesh repair: a prospective study. Surg Endosc 20:1030–1035. https://doi.org/10.1007/s00464-005-0554-2
doi: 10.1007/s00464-005-0554-2
pubmed: 16703430
Kudsi OY, Paluvoi N, Bhurtel P, McCabe Z, El-Jabri R (2015) Robotic repair of ventral hernias: Preliminary findings of a case series of 106 consecutive cases. Am J Robot Surg 2:22–26. https://doi.org/10.1166/ajrs.2015.1020
doi: 10.1166/ajrs.2015.1020
pubmed: 27419223
pmcid: 4941628
Petro CC, Thomas JD, Tu C, Krpata DM, Beffa LR, Rosen MJ, Prabhu AS (2022) Robotic vs laparoscopic ventral hernia repair with intraperitoneal mesh: 1-year exploratory outcomes of the PROVE-IT randomized clinical trial. J Am Coll Surg 234:1160–1165. https://doi.org/10.1097/XCS.0000000000000171
doi: 10.1097/XCS.0000000000000171
pubmed: 35703814
Goodney PP, Birkmeyer CM, Birkmeyer JD (2002) Short-term outcomes of laparoscopic and open ventral hernia repair: a meta-analysis. Arch Surg 137:1161–1165. https://doi.org/10.1001/archsurg.137.10.1161
doi: 10.1001/archsurg.137.10.1161
pubmed: 12361426
Dietz UA, Winkler MS, Härtel RW, Fleischhacker A, Wiegering A, Isbert C, Jurowich C, Heuschmann P, Germer C-T (2014) Importance of recurrence rating, morphology, hernial gap size, and risk factors in ventral and incisional hernia classification. Hernia 18:19–30. https://doi.org/10.1007/s10029-012-0999-x
doi: 10.1007/s10029-012-0999-x
pubmed: 23070583