Operating the inoperable patient: Morbid obesity and complex abdominal wall hernias
EAES Academy. Mesquita Guimarães C. 07/05/22; 363193; P257
Catarina Mesquita Guimarães
Contributions
Contributions
Abstract
Aims:
To describe a group of patients submitted to bariatric surgery who presented with complex abdominal wall hernias at the time of bariatric surgery.
Methods:
We performed a retrospective, descriptive, evaluation of a subgroup of patients with complex abdominal wall hernia from our prospective database that includes all patients submitted to bariatric and/or metabolic surgery from January/2018 to September/2021 by the Bariatric Surgery Group of a Portuguese community hospital. We assessed preoperative and post-operative, anthropometric parameters, hernia characteristics, surgical options regarding hernia management, operative parameters and complications.
Results:
This study enrolled eleven patients, who presented with complex abdominal hernias at the time of the bariatric surgery. 82% of the patients were women. The mean body mass index (BMI) at the time of the surgery was 41,5. At the time of the hernia correction surgery the mean BMI was 29,4. The most performed surgery was gastric sleeve (45,4%), followed by gastric bypass (36,4%). 18,2% were one anastomosis gastric bypasses. All surgeries performed were laparoscopic, but two had to be converted due to intraoperative complications. In 72,7% of the patients a no-touch option was performed during surgery. In the other 27,3% reduction of the hernia was necessary to continue the surgery. At least 4 (36.4%) patients had intraoperative or postoperative complications. One patient required reintervention after surgery for an accidental perforation by the trocars. One patient required multiple percutaneous drainages for splenic abscesses.
Conclusions:
Overweight and obesity have been shown to be the most significant predictor of recurrence of incisional hernia repair, with a rate of 1.1 per unit BMI increase above normal. Therefore losing weight before the hernia correction surgery improves hernia outcomes. Based on our study, bariatric surgery with a laparoscopic approach in patients presenting with complex abdominal hernias is feasible, but it’s associated with a significantly higher risk of complications.
To describe a group of patients submitted to bariatric surgery who presented with complex abdominal wall hernias at the time of bariatric surgery.
Methods:
We performed a retrospective, descriptive, evaluation of a subgroup of patients with complex abdominal wall hernia from our prospective database that includes all patients submitted to bariatric and/or metabolic surgery from January/2018 to September/2021 by the Bariatric Surgery Group of a Portuguese community hospital. We assessed preoperative and post-operative, anthropometric parameters, hernia characteristics, surgical options regarding hernia management, operative parameters and complications.
Results:
This study enrolled eleven patients, who presented with complex abdominal hernias at the time of the bariatric surgery. 82% of the patients were women. The mean body mass index (BMI) at the time of the surgery was 41,5. At the time of the hernia correction surgery the mean BMI was 29,4. The most performed surgery was gastric sleeve (45,4%), followed by gastric bypass (36,4%). 18,2% were one anastomosis gastric bypasses. All surgeries performed were laparoscopic, but two had to be converted due to intraoperative complications. In 72,7% of the patients a no-touch option was performed during surgery. In the other 27,3% reduction of the hernia was necessary to continue the surgery. At least 4 (36.4%) patients had intraoperative or postoperative complications. One patient required reintervention after surgery for an accidental perforation by the trocars. One patient required multiple percutaneous drainages for splenic abscesses.
Conclusions:
Overweight and obesity have been shown to be the most significant predictor of recurrence of incisional hernia repair, with a rate of 1.1 per unit BMI increase above normal. Therefore losing weight before the hernia correction surgery improves hernia outcomes. Based on our study, bariatric surgery with a laparoscopic approach in patients presenting with complex abdominal hernias is feasible, but it’s associated with a significantly higher risk of complications.
Aims:
To describe a group of patients submitted to bariatric surgery who presented with complex abdominal wall hernias at the time of bariatric surgery.
Methods:
We performed a retrospective, descriptive, evaluation of a subgroup of patients with complex abdominal wall hernia from our prospective database that includes all patients submitted to bariatric and/or metabolic surgery from January/2018 to September/2021 by the Bariatric Surgery Group of a Portuguese community hospital. We assessed preoperative and post-operative, anthropometric parameters, hernia characteristics, surgical options regarding hernia management, operative parameters and complications.
Results:
This study enrolled eleven patients, who presented with complex abdominal hernias at the time of the bariatric surgery. 82% of the patients were women. The mean body mass index (BMI) at the time of the surgery was 41,5. At the time of the hernia correction surgery the mean BMI was 29,4. The most performed surgery was gastric sleeve (45,4%), followed by gastric bypass (36,4%). 18,2% were one anastomosis gastric bypasses. All surgeries performed were laparoscopic, but two had to be converted due to intraoperative complications. In 72,7% of the patients a no-touch option was performed during surgery. In the other 27,3% reduction of the hernia was necessary to continue the surgery. At least 4 (36.4%) patients had intraoperative or postoperative complications. One patient required reintervention after surgery for an accidental perforation by the trocars. One patient required multiple percutaneous drainages for splenic abscesses.
Conclusions:
Overweight and obesity have been shown to be the most significant predictor of recurrence of incisional hernia repair, with a rate of 1.1 per unit BMI increase above normal. Therefore losing weight before the hernia correction surgery improves hernia outcomes. Based on our study, bariatric surgery with a laparoscopic approach in patients presenting with complex abdominal hernias is feasible, but it’s associated with a significantly higher risk of complications.
To describe a group of patients submitted to bariatric surgery who presented with complex abdominal wall hernias at the time of bariatric surgery.
Methods:
We performed a retrospective, descriptive, evaluation of a subgroup of patients with complex abdominal wall hernia from our prospective database that includes all patients submitted to bariatric and/or metabolic surgery from January/2018 to September/2021 by the Bariatric Surgery Group of a Portuguese community hospital. We assessed preoperative and post-operative, anthropometric parameters, hernia characteristics, surgical options regarding hernia management, operative parameters and complications.
Results:
This study enrolled eleven patients, who presented with complex abdominal hernias at the time of the bariatric surgery. 82% of the patients were women. The mean body mass index (BMI) at the time of the surgery was 41,5. At the time of the hernia correction surgery the mean BMI was 29,4. The most performed surgery was gastric sleeve (45,4%), followed by gastric bypass (36,4%). 18,2% were one anastomosis gastric bypasses. All surgeries performed were laparoscopic, but two had to be converted due to intraoperative complications. In 72,7% of the patients a no-touch option was performed during surgery. In the other 27,3% reduction of the hernia was necessary to continue the surgery. At least 4 (36.4%) patients had intraoperative or postoperative complications. One patient required reintervention after surgery for an accidental perforation by the trocars. One patient required multiple percutaneous drainages for splenic abscesses.
Conclusions:
Overweight and obesity have been shown to be the most significant predictor of recurrence of incisional hernia repair, with a rate of 1.1 per unit BMI increase above normal. Therefore losing weight before the hernia correction surgery improves hernia outcomes. Based on our study, bariatric surgery with a laparoscopic approach in patients presenting with complex abdominal hernias is feasible, but it’s associated with a significantly higher risk of complications.
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