Feasibility of laparoscopic sleeve gastrectomy in patients with severe obesity and complex abdominal wall hernias with loss of domain.

PURPOSE

The literature recommends that patients with complex abdominal wall hernias (CAWH) and severe obesity should be managed with staged treatment, undergoing metabolic and bariatric surgery (MBS) before hernia repair. However, CAWH with loss of domain (LOD) presents a more challenging situation. This study presents the feasibility of Laparoscopic Sleeve Gastrectomy (LSG) in patients with CAWH and LOD.

METHODS

This is a retrospective cohort of unselected consecutive patients with CAWH and LOD defined based on Tanaka and Sabbagh's criteria who underwent LSG from 2016 to 2023. We documented a 90-day complication rate according to the Clavien-Dindo classification.

RESULTS

Sixteen patients, aged 55 ± 10.6 years with a mean BMI of 41.75 ± 4.75 kg/m, met the inclusion criteria. The median hernia sac volume (HSV) was 3331.0 ml (IQR 2647.25-3616.25), achieving a median volume ratio of 44.69% (IQR 33.58-55.69) and 30.88% (IQR 25.14-34.70) according to Tanaka's and Sabbagh's criteria, respectively. There were no intraoperative complications or conversions. Three patients experienced major 90-day complications, with two requiring reoperations. There was no 90-day mortality.

CONCLUSION

LSG in patients with severe obesity and CAWH with loss of domain is safe and feasible but has a higher-than-expected rate of serious morbidity due to the complexity of this patient population.