Belle Vue Clinic, 9 and 10, Loudon street, Kolkata, India.
Hernia. 2021 Jun;25(3):689-699. doi: 10.1007/s10029-020-02318-z. Epub 2020 Oct 12.
Management of ventral hernia in obese is a complex problem. The methods of weight loss, alternatives if the patient cannot undergo bariatric surgery, timing, and type of hernia surgery lacks clarity and are dependent on resources and expertise. There is a need for algorithms based on local population and expertise. In this paper, we present the outcomes of our institutional algorithm.
It was a retrospective analysis of prospectively collected data. Patients with body mass index (BMI) > 30Kg/m were included to undergo surgery as per algorithm taking into account (a) presentation (symptomatic vs asymptomatic), (b) hernia characteristics (defect width, site, reducibility), and (c) obesity characteristics (BMI, subcutaneous fat, android vs gynecoid). Data on age, BMI, comorbidities, tobacco consumption, hernia width, location, contents, previous surgery, intraoperative parameters (the type of surgery, mesh, drain, fixation), and outcomes (seroma, hematoma, infection, recurrence) were collected.
A total of 50 patients underwent treatment as per the algorithm. Mean BMI was 36.6 ± 7.3 kg/m. The mean follow-up was 17.6 ± 7.2 months. The mean defect width was 4.8 ± 2.9 cm. There were two (4%) recurrences in patients who underwent an anatomical repair under emergency conditions. None of the patients who underwent an elective repair had a recurrence. Total surgical site occurrence was 12% and surgical site occurrence requiring procedural intervention was 8%. There was one (2%) mortality on postoperative day 7 due to myocardial infarction.
The algorithm has shown encouraging results in the short-to-medium term. Long-term evaluation with a higher number of patients is needed to confirm its usefulness.
肥胖患者的腹疝管理是一个复杂的问题。减重方法、无法接受减重手术患者的替代方法、手术时机和疝手术类型缺乏明确性，且取决于资源和专业知识。需要根据当地人群和专业知识制定算法。本文介绍了我们机构算法的结果。
这是一项前瞻性收集数据的回顾性分析。纳入 BMI＞30kg/m 的患者，根据算法进行手术，同时考虑（a）表现（有症状与无症状）、（b）疝特征（缺损宽度、部位、可复性）和（c）肥胖特征（BMI、皮下脂肪、男性型或女性型）。收集患者的年龄、BMI、合并症、吸烟情况、疝宽度、位置、内容物、既往手术、术中参数（手术类型、网片、引流管、固定方式）和结局（血清肿、血肿、感染、复发）。
共有 50 名患者根据算法接受了治疗。平均 BMI 为 36.6±7.3kg/m。平均随访时间为 17.6±7.2 个月。平均缺损宽度为 4.8±2.9cm。在紧急情况下行解剖修复的患者中有 2 例（4%）复发。择期修复的患者无一例复发。总手术部位并发症发生率为 12%，需要手术干预的手术部位并发症发生率为 8%。术后第 7 天因心肌梗死导致 1 例（2%）死亡。
该算法在短期至中期显示出令人鼓舞的结果。需要长期评估更多患者以确认其有用性。
