Zhamak Khorgami1, Ivy N Haskins2, Ali Aminian3, Amin Andalib4, Michael J Rosen5, Stacy A Brethauer1, Philip R Schauer1. 1. Bariatric and Metabolic Institute, Department of Surgery, Cleveland Clinic Foundation, Cleveland, Ohio. 2. Comprehensive Hernia Center, Department of Surgery, Cleveland Clinic Foundation, Cleveland, Ohio; Department of Surgery, George Washington University, Washington, DC. 3. Bariatric and Metabolic Institute, Department of Surgery, Cleveland Clinic Foundation, Cleveland, Ohio. Electronic address: aminiaa@ccf.org. 4. Department of Surgery, McGill University, Montreal, Quebec, Canada. 5. Comprehensive Hernia Center, Department of Surgery, Cleveland Clinic Foundation, Cleveland, Ohio.
Abstract
BACKGROUND: There is no consensus regarding the optimal management of ventral hernias encountered during bariatric surgery. OBJECTIVES: To compare early patient morbidity and mortality between those patients undergoing laparoscopic bariatric surgery only and those patients undergoing laparoscopic bariatric surgery with concomitant ventral hernia repair. SETTING: American College of Surgeons National Surgical Quality Improvement Program Database (NSQIP). METHODS: All patients undergoing laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy from 2012-2013 were identified within the NSQIP database. Those patients undergoing concomitant ventral hernia repair were compared with patients undergoing bariatric surgery only using a 1:1 matched analysis. Primary outcomes of interest included differences in 30-day composite adverse events, unplanned 30-day reoperation, and unplanned 30-day readmission to the hospital. RESULTS: A total of 27,608 patients underwent laparoscopic bariatric surgery during the study period; 988 (3.6%) patients underwent concomitant ventral hernia repair. After 1:1 matching, 1976 patients were evaluated. In terms of 30-day patient morbidity, patients who underwent concomitant ventral hernia were significantly more likely to experience all primary outcomes of interest, including composite adverse events (P = .01), a higher rate of unplanned return to the operating room (P<.001), and a higher 30-day readmission rate (P = .01). CONCLUSION: Although we were unable to assess specific hernia characteristics from the NSQIP database, patients who underwent concomitant ventral hernia repair with laparoscopic bariatric surgery experience increased 30-day morbidity. Optimal management of concurrent ventral hernias and timing of repair in bariatric surgical patients requires further investigation.
BACKGROUND: There is no consensus regarding the optimal management of ventral hernias encountered during bariatric surgery. OBJECTIVES: To compare early patient morbidity and mortality between those patients undergoing laparoscopic bariatric surgery only and those patients undergoing laparoscopic bariatric surgery with concomitant ventral hernia repair. SETTING: American College of Surgeons National Surgical Quality Improvement Program Database (NSQIP). METHODS: All patients undergoing laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy from 2012-2013 were identified within the NSQIP database. Those patients undergoing concomitant ventral hernia repair were compared with patients undergoing bariatric surgery only using a 1:1 matched analysis. Primary outcomes of interest included differences in 30-day composite adverse events, unplanned 30-day reoperation, and unplanned 30-day readmission to the hospital. RESULTS: A total of 27,608 patients underwent laparoscopic bariatric surgery during the study period; 988 (3.6%) patients underwent concomitant ventral hernia repair. After 1:1 matching, 1976 patients were evaluated. In terms of 30-day patient morbidity, patients who underwent concomitant ventral hernia were significantly more likely to experience all primary outcomes of interest, including composite adverse events (P = .01), a higher rate of unplanned return to the operating room (P<.001), and a higher 30-day readmission rate (P = .01). CONCLUSION: Although we were unable to assess specific hernia characteristics from the NSQIP database, patients who underwent concomitant ventral hernia repair with laparoscopic bariatric surgery experience increased 30-day morbidity. Optimal management of concurrent ventral hernias and timing of repair in bariatric surgical patients requires further investigation.
Authors: Muhammad Moolla; Jerry Dang; Aryan Modasi; Simon Byrns; Noah Switzer; Daniel W Birch; Shahzeer Karmali Journal: J Gastrointest Surg Date: 2019-06-26 Impact factor: 3.452
Authors: K K Jensen; B East; B Jisova; M López Cano; G Cavallaro; L N Jørgensen; V Rodrigues; C Stabilini; D Wouters; F Berrevoet Journal: Hernia Date: 2022-02-25 Impact factor: 2.920
Authors: Kristina H Lewis; David E Arterburn; Katherine Callaway; Fang Zhang; Stephanie Argetsinger; Jamie Wallace; Adolfo Fernandez; Dennis Ross-Degnan; James F Wharam Journal: JAMA Netw Open Date: 2019-12-02