Concurrent minimally invasive bariatric surgery and ventral hernia repair with mesh; Is it safe? Propensity score matching analysis using the 2015-2022 MBSAQIP database

Jennifer Brown; Jorge Cornejo; Alba Zevallos; Joaquin Sarmiento; Jocelyn Powell; Fatemeh Shojaeian; Farzad Mokhtari-Esbuie; Gina Adrales; Christina Li; Raul Sebastian

doi:10.1007/s00464-024-11260-5

Concurrent minimally invasive bariatric surgery and ventral hernia repair with mesh; Is it safe? Propensity score matching analysis using the 2015-2022 MBSAQIP database

Surg Endosc. 2024 Sep 17. doi: 10.1007/s00464-024-11260-5. Online ahead of print.

Authors

Jennifer Brown¹, Jorge Cornejo¹, Alba Zevallos^{1

2}, Joaquin Sarmiento¹, Jocelyn Powell³, Fatemeh Shojaeian⁴, Farzad Mokhtari-Esbuie⁴, Gina Adrales⁴, Christina Li¹, Raul Sebastian^{5

6

7}

Affiliations

¹ Department of Surgery, Northwest Hospital, Randallstown, MD, USA.
² Universidad Científica del Sur, Lima, Peru.
³ Department of Surgery, Sinai Hospital, Baltimore, MD, USA.
⁴ Department of Surgery, The Johns Hopkins University, Baltimore, MD, USA.
⁵ Department of Surgery, Northwest Hospital, Randallstown, MD, USA. Rsebast04@gmail.com.
⁶ Department of Surgery, The Johns Hopkins University, Baltimore, MD, USA. Rsebast04@gmail.com.
⁷ Division of Bariatric and Minimally Invasive Surgery, Northwest Hospital, 5401 Old Court Road, Randallstown, MD, 21133, USA. Rsebast04@gmail.com.

PMID: 39289227
DOI: 10.1007/s00464-024-11260-5

Abstract

Background: Obesity is a risk factor for the development of ventral hernias. Approximately eight percent of patients undergoing bariatric surgery have a concomitant ventral hernia. However, the optimal timing of hernia repair in these patients is debated. Concerns regarding mesh insertion in a potentially contaminated field are often cited by opponents of a combined approach. Our study compares 30-day outcomes of bariatric surgery with concurrent ventral hernia repair with mesh versus bariatric surgery alone.

Methods: Using the 2015-2022 MBSAQIP database, patients aged 18-65 years who underwent minimally invasive sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) with or without concurrent ventral hernia repair with mesh (VHR-M) were identified. 30-day postoperative outcomes were compared between patients who underwent SG or RYGB with VHR-M versus SG or RYGB alone. 1:1 propensity score matching was performed using 26 preoperative characteristics to adjust confounders.

Results: Among 1,236,644 patients who underwent SG (n = 871,326) or RYGB (n = 365,318), 3,121 underwent SG + VHR-M and 2,321 RYGB + VHR-M. The concurrent approach had longer operative times, in SG + VHR-M (86.06 ± 42.78 vs. 73.80 ± 38.45 min, p < 0.001), and in RYGB + VHR-M (141.91 ± 58.68 vs. 128.47 ± 62.37 min, p < 0.001). The RYGB + VHR-M cohort had higher rates of reoperations (3.2% vs. 2.1%, p = 0.024). Overall, 30-day outcomes, and bariatric-specific complications such as mortality, unplanned ICU admissions, surgical site complications, cardiac, pulmonary, renal complications, anastomotic leaks, postoperative bleeding, and intestinal obstruction were similar between SG + VHR-M or RYGB + VHR-M groups versus SG or RYGB alone.

Conclusion: Bariatric surgery performed concurrently with VHR-M is safe and feasible and does not excessively prolong operative times. However, patients undergoing RYGB with VHR-M do have a higher rate of reoperations, therefore a staged VHR is recommended. On the other hand, concurrent SG and VHR-M may benefit after an appropriate individualized risk stratification assessment.

Keywords: Bariatric surgery; Gastric bypass; Minimally invasive surgery; Sleeve gastrectomy; Ventral hernia.