Levy Adam S, Dinesh Anant, Ahmed Leaque, Morrison Norman, Engdahl Ryan
Division of Bariatric Surgery, Department of Surgery, Harlem Hospital Center, and.
Division of Plastic and Reconstructive Surgery, Department of Surgery, Harlem Hospital, Columbia University, New York, NY.
Ann Plast Surg. 2018 Nov;81(5):591-593. doi: 10.1097/SAP.0000000000001546.
An increase in bariatric surgery has led to a rise in postbariatric contouring procedures. Despite a comprehensive preoperative assessment, body habitus in these patients may significantly limit the abdominal exam. Abdominal contouring procedures typically elevate large portions of the skin and fat off the abdominal wall, and unexpected hernia may be discovered intraoperatively. No study to date has characterized such hernia discovery at the time of body contouring surgery. We reviewed our experience of management of incidental hernia found during abdominoplasty or panniculectomy after laparoscopic bariatric surgery.
Records of all post-bariatric surgery patients undergoing abdominal contouring procedures between 2007 and 2017 were reviewed to identify patients with incidental hernias discovered intraoperatively. These patients were further examined by reviewing operative details, patient-specific factors, and outcomes.
Six hundred eighty-one post-bariatric surgery patients underwent abdominal body contouring procedures with incidental ventral hernia discovered in 36 patients (5.3% [45 hernias]). At the time of plastic surgery, average age was 49 years (range, 25-64 years), and body mass index was 30.7 kg/m (range 25-43 kg/m). Of 36 patients with incidental hernia, 26 patients (72.2%) had a single hernia, and the remainder had multiple (27.8%). Mean hernia size was 4.1 cm (range, 0.25-24 cm). Most hernias were located paraumbilical/umbilical (46.7%) or epigastric (37.8%). Ninety-eight percent of hernias were repaired primarily (n = 44) by the plastic surgeon, and in 1 case (2%), mesh repair was performed by a consulting general surgeon. Average follow-up was 1.9 ± 0.3 years. Only 1 patient (2.8%) developed hernia recurrence after 48 months. Other postoperative complications included superficial wound healing problems (19.4%), seroma (16.7%), suture abscess (5.6%), and cellulitis that resolved with antibiotics (5.6%).
This is the first study to characterize incidental hernia discovered at the time of body contouring in the post-bariatric surgery patient. The body contouring surgeon should be aware of this common finding. Hernias typically discovered during panniculectomy or abdominoplasty arise in umbilical or epigastric regions, likely from prior laparoscopic port sites, and can be safely repaired by the plastic surgeon with low overall complication rates.
减肥手术的增加导致了减肥后塑形手术的增多。尽管进行了全面的术前评估，但这些患者的身体状况可能会严重限制腹部检查。腹部塑形手术通常会将腹壁上的大部分皮肤和脂肪掀起，术中可能会发现意外的疝气。迄今为止，尚无研究对塑形手术时发现的此类疝气进行描述。我们回顾了我们在腹腔镜减肥手术后腹壁成形术或腹壁皮肤切除术期间发现的意外疝气的处理经验。
回顾2007年至2017年间所有接受腹部塑形手术的减肥后手术患者的记录，以确定术中发现意外疝气的患者。通过回顾手术细节、患者特定因素和结果对这些患者进行进一步检查。
681例减肥后手术患者接受了腹部塑形手术，其中36例（5.3%[45处疝气]）发现了意外的腹侧疝气。在进行整形手术时，平均年龄为49岁（范围25 - 64岁），体重指数为30.7kg/m²（范围25 - 43kg/m²）。在36例意外疝气患者中，26例（72.2%）有一处疝气，其余患者有多处疝气（27.8%）。平均疝气大小为4.1cm（范围0.25 - 24cm）。大多数疝气位于脐旁/脐部（46.7%）或上腹部（37.8%）。98%的疝气由整形外科医生进行了一期修复（n = 44），1例（2%）由普通外科会诊医生进行了补片修复。平均随访时间为1.9±0.3年。只有1例患者（2.8%）在48个月后出现疝气复发。其他术后并发症包括浅表伤口愈合问题（19.4%）、血清肿（16.7%）、缝线脓肿（5.6%）以及用抗生素治疗后消退的蜂窝织炎（5.6%）。
这是第一项对减肥后手术患者塑形时发现的意外疝气进行描述的研究。塑形外科医生应了解这一常见发现。在腹壁皮肤切除术或腹壁成形术期间通常发现的疝气出现在脐部或上腹部区域，可能源于先前的腹腔镜端口部位，并且整形外科医生可以安全地进行修复，总体并发症发生率较低。
