Do we need to use mesh for hernia repair in massive weight loss patients?
Abstract
Introduction: Ventral hernias are abdominal wall defects often acquired secondary to incision, chronic abdominal stress, or trauma. Abdominal wall hernia repairs are among the most common procedures performed in the United States, with half a million conducted annually. Of those, 350,000 are ventral hernia repairs (VHR). There are many ways in which VHR can be undertaken, with a series of decisions that the surgeon must make including open vs laparoscopic repair, mesh vs suture repair, and other variations in technique. VHR should be tension-free, maintain dynamism and anisotropy, and protect the viscera. The literature supports utilizing prosthetic or biologic mesh to support the hernia repair as this approach decreases recurrence rates. Surgical complications are associated with mesh utilization, hence, if there is a subgroup of patients who may not require mesh, it would be advantageous to identify such.
Methods: This study is a retrospective, case-control study of 32 bariatric patients who underwent a VHR without use of surgical mesh greater than 18 months following massive weight loss surgery. These individuals will be contacted via phone for the opportunity to complete the Abdominal hernia-Q survey which assesses outcomes for those that underwent a VHR.
Results: Out of the 32 patients identified for this study, 10 patients responded, one of which did not wish to participate. Among the 9 participants, the mean number of lifetime operations of any kind was 8.6. 33.3% (n=3) of the participants had a hernia recurrence since the initial operation with Dr. Colen, and 11.1% (n=1) underwent a second hernia repair surgery. One patient noted persistent numbness in the surgical site; no other health issues were reported.
Conclusion: Additional patient participation is being requested as, with the current response rate, meaningful conclusions cannot be reached. Further investigation with larger sample sizes is needed to assess long-term outcomes in the massive weight loss population undergoing VHR without use of surgical mesh.