Do we need to use mesh for hernia repair in massive weight loss patients?
Abstract
Introduction: Ventral Hernias are abdominal wall defects that often occur secondary to surgical incisions, chronic abdominal stress, or other trauma. With obesity, there is increased abdominal stress, so this can increase the risk for developing hernias. To assist in their weight loss, patients may elect to undergo bariatric surgery. Through this procedure, the rate of hernia recurrence following repair also decreases. The standard of care states that repairs using prosthetic mesh for reinforcement are superior to those that do not. However, this can have drawbacks as there are unique complications. Individuals that have lost significant weight following bariatric surgery often have a large amount of excess skin and other soft tissues. This could have a role in hernia repair as an autologous scaffold, challenging the current mesh-based approach.
Methods: To begin, the team obtained a list of patients who underwent ventral hernia repair at least 18 months following bariatric surgery and a >100 pound weight loss. Following that, a chart review was done to learn more about each subject, including their medical history, the closure technique used, number of drains, and any postoperative complications that might have occurred. When this was complete, the patients were contacted by both phone and email to complete the Abdominal Hernia questionnaire, which would be used to assess the long-term outcomes. Specifically, we are interested in the incidence of hernia recurrence.
Results: Of the 32 subjects that met our inclusion criteria, nine chose to participate in the study. Three mentioned that they had a recurrence of a hernia, one of who noted that they had numbness of the abdominal wall following our surgery. Only one of the three chose to have another repair.
Conclusion: The data collected shows that using abdominal fascia is a plausible method for hernia repair, however 30% of the responses indicated a recurrence. So far, the response rate for our survey is poor and it is difficult to draw any meaningful conclusions. We hope to increase the number of participants in order to better assess the need for prosthetic reinforcement when hernia repair is required in the massive weight loss patient.