Hernia recurrence after concomitant laparoscopic ventral hernia repair using intraperitoneal biologic mesh: a retrospective analysis.

PURPOSE: Evidence is compelling for the safety and acceptable short-term outcomes of concomitant bariatric surgery (BS) and laparoscopic ventral hernia repair (LVHR). No studies have examined patient characteristics that may guide selection between concomitant LVHR and staged operations in patients undergoing laparoscopic Roux-en-Y (LRNY) or sleeve gastrectomy (LSG).

METHODS

A retrospective analysis of patients with concomitant LRNY or LSG and LVHR from 2013–2015. The association of demographics, comorbidities, hernia characteristics, repair technique, and post-operative weight regain was assessed based on hernia recurrence.

RESULTS

We included 90 patients, stratified by hernia recurrence (yes: N = 30, 33.3%, no: N = 60, 66.7%). Median follow-up was equivalent (58.0 months vs. 55.5 months, p = 0.45). The recurrence group had higher rates of cardiovascular disease (CVD) (86.7% vs. 63.3%, p = 0.04), chronic obstructive pulmonary disease (COPD) (13.3% vs. 1.7%, p = 0.04), and prior ventral hernia repair (20.0% vs. 3.3%, p = 0.02) There was no difference in age, pre-operative BMI, defect size, hernia reducibility or use of mesh. Most LVHR (83.3%) recurred before achieving nadir weight. An exploratory decision tree analysis found an age threshold of 45.3 years for hernia recurrence, where frequency increases from 16.1% to 42.4%. Patients > 45.3 years had increased CVD (83.1% vs. 48.4%, p = 0.001) and hypertension (81.4% vs. 48.4%, p = 0.003), but a lower pre-surgery BMI (45.5 vs. 52.1, p = 0.01).

CONCLUSION

Hernia recurrence after concomitant BS and LVHR is likely not associated with weight regain, as most patients recur before reaching nadir weight. However, older patients with CVD and prior ventral hernia repairs demonstrated higher recurrence rates and may warrant consideration of staged operations.