Concurrent Gastric Bypass and Repair of Anterior Abdominal Wall Hernias |
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| Authors: | Rob Schuster MD Myriam J Curet MD FACS Ramzi S Alami MD John M Morton MD MPH FACS Sherry M Wren MD FACS Bassem Y Safadi MD FACS |
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| Institution: | (1) Palo Alto Veterans Health Care System Departments of Surgery and Stanford University School of Medicine, Department of Surgery, Stanford, CA, USA;(2) Palo Alto Veterans Health Care System Departments of Surgery and Stanford University School of Medicine, Department of Surgery, Stanford, CA, USA;(3) Palo Alto Veterans Health Care System Departments of Surgery and Stanford University School of Medicine, Department of Surgery, Stanford, CA, USA;(4) Palo Alto Veterans Health Care System Departments of Surgery and Stanford University School of Medicine, Department of Surgery, Stanford, CA, USA;(5) Palo Alto Veterans Health Care System Departments of Surgery and Stanford University School of Medicine, Department of Surgery, Stanford, CA, USA;(6) Palo Alto Veterans Health Care System Departments of Surgery and Stanford University School of Medicine, Department of Surgery, Stanford, CA, USA |
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| Abstract: | Background: Many patients seeking surgical treatment for morbid obesity present with anterior abdominal wall hernias. Although
principles of hernia repair involve a tension-free repair with the use of prosthetic mesh, there is concern about the use
of mesh in gastric bypass surgery due to potential contamination with the contents of the gastrointestinal tract and resultant
mesh infection. We report our series of patients undergoing Roux-en-Y gastric bypass (RYGBP) and simultaneous anterior abdominal
wall hernia repair. Methods: All patients who underwent simultaneous RYGBP surgery and anterior abdominal wall hernia repair
were reviewed. Results: 12 patients underwent concurrent RYGBP and anterior wall hernia repair. There were 5 women and 7 men
with average age 54.9 ± 8.5 years (range 35 to 64) and average body mass index (BMI) 50.4 ± 10.3 kg/m2 (range 38 to 70). Two open and 10 laparoscopic RYGBP operations were performed. Nine patients (75%) underwent incisional
hernia repairs and 3 patients (25%) underwent umbilical hernia repair concurrent with gastric bypass. Average size of defect
was 14.7 ± 13.4 cm2. One patient had primary repair and 11 patients had prosthetic mesh repair: polypropylene in 3 patients (25%) and polyester
in 8 patients (67%). With a 14.1 ± 9.3 month follow-up, there have been no mesh infections and 2 recurrences, one in the patient
who underwent primary repair and one in a patient repaired with polyester mesh but with two previous failed incisional hernia
repairs. Conclusion: Concurrent RYGBP and repair of anterior abdominal wall hernias is safe and feasible. In order to optimize
success, tension-free principles of hernia repair with the use of prosthetic mesh should be followed since no mesh infections
occurred in our series. |
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| Keywords: | MORBID OBESITY GASTRIC BYPASS HERNIA RECURRENCE MESH |
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