Israeli Center for Bariatric Surgery (ICBS), Assia Medical Group, Assuta Medical Center, Tel Aviv, Israel.
Surg Endosc. 2014 Apr;28(4):1209-12. doi: 10.1007/s00464-013-3310-z. Epub 2013 Nov 20.
Ventral hernias are not uncommon in the bariatric population. Their management is technically demanding and remains controversial. Hernia complications can be lethal after bariatric surgery (BS). We herein report our experience with concomitant BS and ventral hernia repair (VHR).
We performed a retrospective analysis of a prospectively maintained database queried for combined procedures. Hernias were repaired after complete reduction (when the defect was not empty) using a dual mesh fixed to the abdominal wall with absorbable tackers. Data collected included demographics, anthropometrics, co-morbidities, peri-operative course, and intermediate weight loss and co-morbidity status.
Between 2007 and 2012, a total of 54 patients (34 females, mean body mass index 44.2 kg/m(2)) underwent concomitant BS and VHR. The vast majority of procedures were laparoscopic sleeve gastrectomies (N = 48; 89 %). Others included laparoscopic Roux-en-y gastric bypass (RYGB), open RYGB, and laparoscopic gastric banding (two each). Six patients had complications (11 %): three leaks, two abdominal wall hematomas, and one pulmonary embolism. Hernia recurrence was noted in one patient (1.8 %). Average excess weight loss post-surgery was 49.9 ± 10.3 and 57.7 ± 9.2 % at 6 and 12 months, respectively. The total number of pre-operative co-morbidities was 110. At 12-month follow-up, 50 % (N = 56) were completely resolved and 38 % (N = 42) were improved.
Concomitant BS and VHR is feasible and safe, obviating the need for two separate procedures while not hampering the outcome of either. Complication rates for the combined surgery do not seem to be adversely affected.
减重手术后的患者常发生腹壁疝，其处理具有一定难度，且存在争议。减重手术后发生疝并发症可能是致命的。我们在此报告我们在减重手术（BS）同期进行腹壁疝修补（VHR）的经验。
我们对前瞻性维护的数据库进行了回顾性分析，对联合手术进行了查询。当缺损未排空时（即不全疝），采用双网片固定于腹壁并用可吸收缝线固定的方法进行疝修补。收集的数据包括人口统计学、人体测量学、合并症、围手术期过程以及中期减重和合并症状态。
2007 年至 2012 年，共有 54 例患者（34 例女性，平均 BMI 为 44.2kg/m²）同时接受 BS 和 VHR。绝大多数手术为腹腔镜袖状胃切除术（N=48；89%）。其他术式包括腹腔镜 Roux-en-y 胃旁路术（RYGB）、开腹 RYGB 和腹腔镜胃绑带术（各 2 例）。6 例患者出现并发症（11%）：3 例吻合口漏，2 例腹壁血肿，1 例肺栓塞。1 例患者（1.8%）出现疝复发。术后平均超重体重减轻量分别为术后 6 个月时的 49.9±10.3%和 12 个月时的 57.7±9.2%。术前合并症总数为 110 例。12 个月随访时，50%（N=56）完全缓解，38%（N=42）改善。
BS 和 VHR 同期进行是可行且安全的，避免了两次单独手术，且不影响任何一次手术的结果。联合手术的并发症发生率似乎并未受到不利影响。
