Abstract
Background
Morbidity and recurrence rates are higher in obese patients undergoing open abdominal wall reconstruction (AWR). Historically, body mass index (BMI) ≥ 40 has served as a relative contraindication to open AWR. The purpose of this study is to evaluate the impact of minimally invasive surgery (MIS) on outcomes after AWR for higher versus lower BMI patients.
Methods
A retrospective review of a prospectively maintained database was conducted of all patients who underwent MIS AWR between September 2015 and April 2019 at our institution. Patients were subdivided into two groups based on their BMI: BMI ≤ 35 kg/m2 and BMI > 35 kg/m2. Patient demographics and perioperative data were evaluated using univariate and multivariate analysis.
Results
461 patients were identified and divided into two groups: BMI ≤ 35 (n = 310) and BMI > 35 (n = 151). The two groups were similar in age (BMI ≤ 35: 56.3 ± 14.1 years vs. BMI > 35: 54.4 ± 11.9, p = .154). BMI > 35 group had more patients with ASA score of 3 (81% vs. 32%, p < .001) and comorbid conditions such as hypertension (70% vs. 45%, p < .001), diabetes mellitus (32% vs. 15%, p < .001), and history of recurrent abdominal wall hernia (34% vs. 23%, p = .008). BMI > 35 group underwent a robotic approach at higher rates (74% vs. 45%, p < .001). Patients who underwent a Rives–Stoppa repair from the higher BMI cohort also had a larger defect size (5.6 ± 2.4 cm vs. 6.7 ± 2.4 cm, p = .004). However, there were no differences in defect size in patients who underwent a transversus abdominus release (BMI ≤ 35: 9.7 ± 4.9 cm vs. BMI > 35: 11.1 ± 4.6 cm, p = .069). Both groups benefited similarly from a short length of stay, similar hospital charges, and lower postoperative complications.
Conclusion
Initial findings of our data support the benefits of elective MIS approach to AWR for patients with higher BMI. These patients derive similar benefits, such as faster recovery with low recurrence rates, when compared to lower BMI patients, while avoiding preoperative hernia incarceration, postoperative wound complications, and hernia recurrences. Future follow-up is required to establish long-term perioperative and quality of life outcomes in this patient cohort.
Similar content being viewed by others
Change history
02 November 2020
A Correction to this paper has been published: https://doi.org/10.1007/s00464-020-08132-z
References
Poulose BK, Shelton J, Phillips S et al (2012) Epidemiology and cost of ventral hernia repair: making the case for hernia research. Hernia. https://doi.org/10.1007/s10029-011-0879-9
Birgisson G, Park AE, Mastrangelo MJ, Witzke DB, Chu UB (2001) Obesity and laparoscopic repair of ventral hernias. Surg Endosc. https://doi.org/10.1007/s004640080077
Danzig MR, Stey AM, Yin SS, Qiu S, Divino CM (2016) Patient profiles and outcomes following repair of irreducible and reducible Ventral Wall Hernias. Hernia. https://doi.org/10.1007/s10029-015-1381-6
Goodenough CJ, Ko TC, Kao LS et al (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. https://doi.org/10.1016/j.jamcollsurg.2014.12.027
Owei L, Swendiman RA, Kelz RR, Dempsey DT, Dumon KR (2017) Impact of body mass index on open ventral hernia repair: a retrospective review. Surg (United States) 162(6):1320–1329. https://doi.org/10.1016/j.surg.2017.07.025
Al Chalabi H, Larkin J, Mehigan B, McCormick P (2015) A systematic review of laparoscopic versus open abdominal incisional hernia repair, with meta-analysis of randomized controlled trials. Int J Surg. https://doi.org/10.1016/j.ijsu.2015.05.050
DeMaria EJ, Moss JM, Sugerman HJ (2000) Laparoscopic intraperitoneal polytetrafluoroethylene (PTFE) prosthetic patch repair of ventral hernia: prospective comparison to open prefascial polypropylene mesh repair. Surg Endosc. https://doi.org/10.1007/s004640020013
Fekkes JF, Velanovich V (2015) Amelioration of the effects of obesity on short-term postoperative complications of laparoscopic and open ventral hernia repair. Surg Laparosc Endosc Percutaneous Tech 25(2):151–157. https://doi.org/10.1097/SLE.0000000000000100
Heniford BT, Park A, Ramshaw BJ, Voeller G, Hunter JG, Fitzgibbons RJ (2003) Laparoscopic repair of ventral hernias: nine years’ experience with 850 consecutive hernias. Ann Surg. https://doi.org/10.1097/01.sla.0000086662.49499.ab
Belyansky I, Daes J, Radu VG et al (2018) A novel approach using the enhanced-view totally extraperitoneal (eTEP) technique for laparoscopic retromuscular hernia repair. Surg Endosc 32(3):1525–1532. https://doi.org/10.1007/s00464-017-5840-2
Mueck KM, Holihan JL, Mo J et al (2017) Computed tomography findings associated with the risk for emergency ventral hernia repair. Am J Surg 214(1):42–46. https://doi.org/10.1016/j.amjsurg.2016.09.035
Beadles CA, Meagher AD, Charles AG (2015) Trends in emergent hernia repair in the united states. JAMA Surg 150(3):194–200. https://doi.org/10.1001/jamasurg.2014.1242
Kao AM, Huntington CR, Otero J et al (2018) Emergent laparoscopic ventral hernia repairs. J Surg Res 232:497–502. https://doi.org/10.1016/j.jss.2018.07.034
Azin A, Hirpara D, Jackson T et al (2019) Emergency laparoscopic and open repair of incarcerated ventral hernias: a multi-institutional comparative analysis with coarsened exact matching. Surg Endosc. https://doi.org/10.1007/s00464-018-6573-6
Tolino MJ, Tripoloni DE, Ratto R, García MI (2009) Infections associated with prosthetic repairs of abdominal wall hernias: pathology, management and results. Hernia. https://doi.org/10.1007/s10029-009-0541-y
Weltz AS, Sibia US, Reza Zahiri H, Schoeneborn A, Park A, Belyansky I (2017) Operative outcomes after open abdominal wall reconstruction with retromuscular mesh fixation using fibrin glue versus transfascial sutures. Am Surg 83:937–942
Lu R, Addo A, Ewart Z et al (2019) Comparative review of outcomes: laparoscopic and robotic enhanced-view totally extraperitoneal (eTEP) access retrorectus repairs. Surg Endosc. https://doi.org/10.1007/s00464-019-07132-y
Belyansky I, Weltz AS, Sibia US et al (2018) The trend toward minimally invasive complex abdominal wall reconstruction: is it worth it? Surg Endosc. https://doi.org/10.1007/s00464-017-5850-0
Rosen MJ, Aydogdu K, Grafmiller K, Petro CC, Faiman GH, Prabhu A (2015) A multidisciplinary approach to medical weight loss prior to complex abdominal wall reconstruction: is it feasible? J Gastrointest Surg. https://doi.org/10.1007/s11605-015-2856-6
Funding
No financial support was received for this study.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosures
Dr. Belyansky reports personal fees from Intuitive, Medtronic, Gore and ownership in IHC Inc outside the submitted work. Dr. Park reports Grants and personal fees from Stryker outside of the submitted work. Drs. Addo, Lu, George, Zahiri, Mr. Broda, and Mr. Huerta have no conflict of interest or financial or relevant financial ties to disclose.
Ethical approval
All authors certify that they accept responsibility as an author and have contributed to the concept, data gathering, analysis, manuscript drafting, and give their final approval.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
This article was updated to correct the labeling of major column 3 in Table 2 to read “BMI > 35,” not “BMI ≤ 35.”
Rights and permissions
About this article
Cite this article
Addo, A., Lu, R., Broda, A. et al. Impact of Body Mass Index (BMI) on perioperative outcomes following minimally invasive retromuscular abdominal wall reconstruction: a comparative analysis. Surg Endosc 35, 5796–5802 (2021). https://doi.org/10.1007/s00464-020-08069-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-020-08069-3