The role of gastric restrictive procedures in treating ventral hernias in morbidly obese patients.

INTRODUCTION: Ventral hernia repair in severely obese patients represents a therapeutic challenge associated with the potential of recurrence. It was our intention in the management of patients with symptomatic ventral hernias in the presence of severe obesity to ascertain the role of weight loss produced by a gastric restrictive procedure (GRP) in the management of the hernias.
METHODS: Thirty-three patients underwent ventral hernia repair and a primary GRP while 37 patients underwent ventral hernia repair and revision of a failed GRP associated with unsatisfactory weight loss. Patients were followed to ascertain the effect of the GRP on body weight and the incidence of recurrent hernia.
RESULTS: The mean +/- SEM weight in the patients undergoing primary GRPs and ventral hernia repair was 378 +/- 13 lbs (range 604 to 299 lbs) and the weight of the patients undergoing revision of GRPs and ventral hernia repair was 309 +/- 12 lbs (range 505 to 240 lbs). Mean length of follow-up was 79 +/- 18 months (range 180 to 11 months). Mean +/- SEM weight loss following the primary GRP or the GRP revision was 157 +/- 28 lbs (range 82 to 294 lbs). Repair of recurrent ventral hernia was required following stabilization of weight loss in 11 patients (16%). Long term evaluation of all patients following weight loss identified a 5% incidence of recurrent ventral hernia in those patients who had a body weight less than 200 lbs compared to a 19% incidence of recurrent ventral hernia in patients who weighed between 200 and 250 lbs. Patients who stabilized with a body weight greater than 250 lbs had a ventral hernia recurrence rate of 33%.
CONCLUSION: GRPs have the potential to decrease body weight and contribute to the control of ventral hernias; however, it appears to be necessary to reach a body weight of less than 200 lbs to significantly decrease recurrent hernia formation.