Brown Jennifer, Cornejo Jorge, Zevallos Alba, Sarmiento Joaquin, Powell Jocelyn, Shojaeian Fatemeh, Mokhtari-Esbuie Farzad, Adrales Gina, Li Christina, Sebastian Raul
Department of Surgery, Northwest Hospital, Randallstown, MD, USA.
Universidad Científica del Sur, Lima, Peru.
Surg Endosc. 2024 Dec;38(12):7544-7551. doi: 10.1007/s00464-024-11260-5. Epub 2024 Sep 17.
Obesity is a risk factor for the development of ventral hernias. Approximately eight percent of patients undergoing bariatric surgery have a concomitant ventral hernia. However, the optimal timing of hernia repair in these patients is debated. Concerns regarding mesh insertion in a potentially contaminated field are often cited by opponents of a combined approach. Our study compares 30-day outcomes of bariatric surgery with concurrent ventral hernia repair with mesh versus bariatric surgery alone.
Using the 2015-2022 MBSAQIP database, patients aged 18-65 years who underwent minimally invasive sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) with or without concurrent ventral hernia repair with mesh (VHR-M) were identified. 30-day postoperative outcomes were compared between patients who underwent SG or RYGB with VHR-M versus SG or RYGB alone. 1:1 propensity score matching was performed using 26 preoperative characteristics to adjust confounders.
Among 1,236,644 patients who underwent SG (n = 871,326) or RYGB (n = 365,318), 3,121 underwent SG + VHR-M and 2,321 RYGB + VHR-M. The concurrent approach had longer operative times, in SG + VHR-M (86.06 ± 42.78 vs. 73.80 ± 38.45 min, p < 0.001), and in RYGB + VHR-M (141.91 ± 58.68 vs. 128.47 ± 62.37 min, p < 0.001). The RYGB + VHR-M cohort had higher rates of reoperations (3.2% vs. 2.1%, p = 0.024). Overall, 30-day outcomes, and bariatric-specific complications such as mortality, unplanned ICU admissions, surgical site complications, cardiac, pulmonary, renal complications, anastomotic leaks, postoperative bleeding, and intestinal obstruction were similar between SG + VHR-M or RYGB + VHR-M groups versus SG or RYGB alone.
Bariatric surgery performed concurrently with VHR-M is safe and feasible and does not excessively prolong operative times. However, patients undergoing RYGB with VHR-M do have a higher rate of reoperations, therefore a staged VHR is recommended. On the other hand, concurrent SG and VHR-M may benefit after an appropriate individualized risk stratification assessment.
肥胖是腹疝发生的一个危险因素。接受减肥手术的患者中约8%伴有腹疝。然而，这些患者疝修补的最佳时机仍存在争议。联合手术方法的反对者经常提到对在潜在污染区域植入补片的担忧。我们的研究比较了减肥手术同期行腹疝补片修补与单纯减肥手术的30天结局。
利用2015 - 2022年MBSAQIP数据库，确定年龄在18 - 65岁之间、接受了微创袖状胃切除术（SG）或Roux - en - Y胃旁路术（RYGB）且有或没有同期腹疝补片修补术（VHR - M）的患者。比较接受SG或RYGB联合VHR - M与单纯接受SG或RYGB的患者术后30天的结局。使用26项术前特征进行1:1倾向评分匹配以调整混杂因素。
在1,236,644例接受SG（n = 871,326）或RYGB（n = 365,318）的患者中，3121例接受了SG + VHR - M，2321例接受了RYGB + VHR - M。联合手术方法的手术时间更长，SG + VHR - M组为（86.06 ± 42.78 vs. 73.80 ± 38.45分钟，p < 0.001），RYGB + VHR - M组为（141.91 ± 58.68 vs. 128.47 ± 62.37分钟，p < 0.001）。RYGB + VHR - M队列的再次手术率更高（3.2%对2.1%，p = 0.024）。总体而言，SG + VHR - M或RYGB + VHR - M组与单纯SG或RYGB组之间的30天结局以及减肥手术特异性并发症，如死亡率、非计划入住重症监护病房、手术部位并发症、心脏、肺部、肾脏并发症、吻合口漏、术后出血和肠梗阻等相似。
减肥手术同期行VHR - M是安全可行的，且不会过度延长手术时间。然而，接受RYGB联合VHR - M的患者再次手术率确实较高，因此建议分期进行VHR。另一方面，在进行适当的个体化风险分层评估后，同期SG和VHR - M可能有益。
