Skip to main content
SpringerLink
Log in

Laparoscopic sleeve gastrectomy in patients with complex abdominal wall hernias

  • 2020 SAGES Oral
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Patients with severe obesity and complex abdominal wall hernias (CAWH) present a challenging clinical dilemma. Their body mass index (BMI) is often prohibitive of successful ventral hernia repair (VHR) and the CAWH presents technical challenges when pursuing bariatric surgery. Our hernia center policy is to refer patients with severe obesity for evaluation with the surgical weight loss program. This study describes outcomes of laparoscopic sleeve gastrectomy (LSG) in patients with both severe obesity and CAWH.

Methods

A retrospective analysis was performed on data prospectively collected between 2014 and 2020. CAWH patients referred for and undergoing LSG were included. Revisional bariatric surgery patients were excluded. The dataset was augmented with operative time, BMI changes, length of stay (LOS), hernia characteristics, postoperative complications, time from referral to weight loss surgery, and time from LSG to VHR.

Results

Twenty patients (10 males, mean age 54.3 years) met inclusion criteria. Mean BMI at LSG was 45.6 ± 6.1 kg/m2. Mean hernia area was 494.9 ± 221.2 cm2 and 90% had hernia extension into the subxiphoid and/or epigastric regions. Mean time from bariatric referral to LSG was 10.5 ± 5.4 months. Mean LSG operative time was 121.2 ± 50.3 min, and mean LOS was 1.6 ± 0.8 days. One patient had postoperative bleeding necessitating laparoscopic re-exploration. There were no readmissions. Sixteen patients subsequently underwent VHR on average13.5 ± 11.7 months later and on average 22.6 ± 12.5 months after initial hernia consultation. Two patients had a hernia-related complication between the period of initial hernia consultation and ultimate repair. Mean BMI was 37.5 ± 7.5 kg/m2 (mean 20.7 ± 12.3% decrease, p < 0.0001) at mean follow-up of 27.2 ± 17.2 months.

Conclusions

LSG can be performed successfully even in patients with CAWH. Outcomes do not appear to differ significantly from typical patients undergoing LSG. Further study with larger cohorts is warranted to better delineate complication rates in this population as well as to determine long-term outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Gloy VL, Briel M, Bhatt DL, Kashyap SR, Schauer PR, Mingrone G, Bucher HC, Nordmann AJ (2013) Bariatric surgery versus non-surgical treatment for obesity: a systematic review and meta-analysis of randomised controlled trials. BMJ. https://doi.org/10.1136/bmj.f5934

    Article  PubMed  PubMed Central  Google Scholar 

  2. Colquitt JL, Pickett K, Loveman E, Frampton GK (2014) Surgery for weight loss in adults. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD003641.pub4

    Article  PubMed  Google Scholar 

  3. Fischer JP, Basta MN, Mirzabeigi MN, Bauder AR, Fox JP, Drebin JA, Serletti JM, Kovach SJ (2016) A risk model and cost analysis of incisional hernia after elective, abdominal surgery based upon 12,373 cases: the case for targeted prophylactic intervention. Ann Surg 263:1010–1017

    Article  Google Scholar 

  4. Goodenough CJ, Ko TC, Kao LS, Nguyen MT, Holihan JL, Alawadi Z, Nguyen DH, Flores JR, Arita NT, Roth JS, Liang MK (2015) Development and validation of a risk stratification score for ventral incisional hernia after abdominal surgery: Hernia expectation rates in intra-abdominal surgery (The HERNIA Project). J Am Coll Surg 220:405–413

    Article  Google Scholar 

  5. Lau B, Kim H, Haigh PI, Tejirian T (2012) Obesity increases the odds of acquiring and incarcerating noninguinal abdominal wall hernias. Am Surg 78:1118–1121

    Article  Google Scholar 

  6. Eid G, Mattar S, 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

    Article  CAS  Google Scholar 

  7. Berger RL, Li LT, Hicks SC, Davila JA, Kao LS, Liang MK (2013) Development and validation of a risk-stratification score for surgical site occurrence and surgical site infection after open ventral hernia repair. J Am Coll Surg 217:974–982

    Article  Google Scholar 

  8. Lazzati A, Nassif GB, Paolino L (2018) Concomitant ventral hernia repair and bariatric surgery: a systematic review. Obes Surg 28:2949–2955

    Article  Google Scholar 

  9. Borbély Y, Zerkowski J, Altmeier J, Eschenburg A, Kröll D, Nett P (2017) Complex hernias with loss of domain in morbidly obese patients: role of laparoscopic sleeve gastrectomy in a multi-step approach. Surg Obes Relat Dis 13:768–773

    Article  Google Scholar 

  10. Borud LJ, Grunwaldt L, Janz B, Mun E, Slavin SA (2007) Components separation combined with abdominal wall plication for repair of large abdominal wall hernias following bariatric surgery. Plast Reconstr Surg 119:1792–1798

    Article  CAS  Google Scholar 

  11. Newcomb WL, Polhill JL, Chen AY, Kuwada TS, Gersin KS, Getz SB, Kercher KW, Heniford BT (2008) Staged hernia repair preceded by gastric bypass for the treatment of morbidly obese patients with complex ventral hernias. Hernia 12:465–469

    Article  CAS  Google Scholar 

  12. Slater NJ, Montgomery A, Berrevoet F, Carbonell AM, Chang A, Franklin M, Kercher KW, Lammers BJ, Parra-Davilla E, Roll S, Towfigh S, van Geffen E, Conze J, van Goor H (2014) Criteria for definition of a complex abdominal wall hernia. Hernia 18:7–17

    Article  CAS  Google Scholar 

  13. Piccoli M, Agresta F, Attinà GM, Amabile D, Marchi D, "Complex Abdominal Wall Study" Italian Collaborative Group (2019) "Complex abdominal wall" management: evidence-based guidelines of the Italian Consensus Conference. Updates Surg 71:255–272

    Article  Google Scholar 

  14. Mechanick JI, Youdim A, Jones DB, Garvey WT, Hurley DL, McMahon MM, Heinberg LJ, Kushner R, Adams TD, Shikora S, Dixon JB, Brethauer S, American Association of Clinical Endocrinologists, The Obesity Society, American Society for Metabolic, and Bariatric Surgery (2013) Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: Cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity (Silver Spring) 21:S1–S27

    Article  CAS  Google Scholar 

  15. Ali M, El Chaar M, Ghiassi S, Rogers AM (2017) American Society for Metabolic and Bariatric Surgery updated position statement on sleeve gastrectomy as a bariatric procedure. Surg Obes Relat Dis 13:1652–1657

    Article  Google Scholar 

  16. Lo Menzo E, Hinojosa M, Carbonell A, Krpata D, Carter J, Rogers AM (2018) American Society for Metabolic and Bariatric Surgery and American Hernia Society consensus guideline on bariatric surgery and hernia surgery. Surg Obes Relat Dis 14:1221–1232

    Article  Google Scholar 

  17. Liang MK, Holihan JL, Itani K, Alawadi ZM, Flores Gonzalez JR, Askenasy EP, Ballecer C, Chong HS, Goldblatt MI, Greenberg JA, Harvin JA, Keith JN, Martindale RB, Orenstein S, Richmond B, Roth JS, Szotek P, Towfigh S, Tsuda S, Vaziri K, Berger DH (2017) Ventral hernia management: expert consensus guided by systematic review. Ann Surg 265:80–89

    Article  Google Scholar 

  18. Pernar LI, Pernar CH, Dieffenbach BV, Brooks DC, Smink DS, Tavakkoli A (2017) What is the BMI threshold for open ventral hernia repair? Surg Endosc 31:1311–1317

    Article  Google Scholar 

  19. Winder JS, Behar BJ, Juza RM, Potochny J, Pauli EM (2016) Transversus abdmoninis release for abdominal wall reconstruction: Early experience with a novel technique. J Am Coll Surg 223:271–278

    Article  Google Scholar 

  20. Iossa A, Coluzzi I, Giannetta IB, Silecchia G (2020) Weight loss and eating patterns 7 years after sleeve gastrectomy: Experience of a bariatric center of excellence. Obes Surg. https://doi.org/10.1007/s11695-020-04699-7

    Article  PubMed  Google Scholar 

  21. Karmali S, Brar B, Shi X, Am S, de Gara C, Birch DW (2013) Weight recidivism post-bariatric surgery: A systematic review. Obes Surg 22:927–934

    Google Scholar 

  22. King WC, Hinerman AS, Courcoulas AP (2020) Weight regain after bariatric surgery: A systematic literature review and comparison across studies using a large reference sample. Surg Obes Relat Dis. https://doi.org/10.1016/j.soard.2020.03.034

    Article  PubMed  PubMed Central  Google Scholar 

  23. Maciejewski ML, Arterburn DE, Scoyoc LV, Smith VA, Yancy WS, Weidenbacher HJ, Livingston EH, Olsen MK (2016) Bariatric surgery and long-term durability of weight loss. JAMA Surg 151:1046–1055

    Article  Google Scholar 

  24. Odom J, Zalesin KC, Washington TL, Miller WW, Hakmeh B, Zeremba DL, Altattan M, Balasubramaniam M, Gibbs DS, Krause KR, Chengelis DL, Franklin BA, McCullough PA (2010) Behavorial predictors of weight regain after bariatric surgery. Obes Surg 20:349–356

    Article  Google Scholar 

  25. Ssentongo P, DeLong CG, Ssentongo AE, Pauli EM, Soybel DI (2020) Exhortation to lose weight prior to complex ventral hernia repair: nudge of noodge? Am J Surg 219:136–139

    Article  Google Scholar 

Download references

Acknowledgements

The authors have no acknowledgments to make.

Author information

Authors and Affiliations

  1. Department of Surgery, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, M.C. H149, Hershey, PA, 17033, USA

    David J. Morrell, Eric M. Pauli, Jerome R. Lyn-Sue, Randy S. Haluck & Ann M. Rogers

Authors
  1. David J. Morrell
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eric M. Pauli
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jerome R. Lyn-Sue
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Randy S. Haluck
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ann M. Rogers
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David J. Morrell.

Ethics declarations

Disclosures

Eric Pauli reports teaching honoraria, research support, and Data and Safety Monitoring Board membership for Beckton, Dickinson and Company (BD), teaching honoraria and consultant fees from Boston Scientific Corp., teaching honoraria from Cook Biotech, Inc., consulting fees and research support from Actuated Medical, Inc., royalties from Springer, royalties from UpToDate, Inc., consulting fees from Wells Fargo & Company, consulting fees from CMS Robotics, teaching honoraria from Medtronic, PLC, and consulting fees from Baxter International, Inc. outside the submitted work. David Morrell, Jerome Lyn-Sue, Randy Haluck, and Ann Rogers have no conflicts of interest or financial ties to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Morrell, D.J., Pauli, E.M., Lyn-Sue, J.R. et al. Laparoscopic sleeve gastrectomy in patients with complex abdominal wall hernias. Surg Endosc 35, 3881–3889 (2021). https://doi.org/10.1007/s00464-020-07831-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-020-07831-x

Keywords

Search

Navigation