Morbidity and mortality of incisional hernia repairs in patients with obesity: a retrospective bicentric study on the impact of an initial bariatric surgery approach.

BACKGROUND

Abdominal hernias are a prevalent complication of abdominal surgery, occurring in 13% of midline laparotomy. The recurrence rate is considerable, reaching 28% within 2 years postrepair. The most significant factor contributing to recurrence after hernia repair and complications is obesity.

OBJECTIVES

This study assesses the impact of a two-stage approach, comprising initial bariatric surgery (BS) followed by hernia repair, on morbidity and mortality associated with hernia surgery.

SETTING

Bicentric retrospective study conducted at two university hospitals (France).

METHODS

Patients with obesity who were eligible for BS and underwent incisional hernia repair (IHR) between January 2013 and August 2023 were divided into two groups: those who underwent IHR alone and those who received initial BS followed by IHR. Data included demographic, anthropometric, and procedural details, as well as short- and long-term complications.

RESULTS

The 140 patients were divided into two groups: 103 undergoing IHR alone (body mass index [BMI] 40.5kg/m) and 37 in the BS-then-IHR group (BMI reduction from 43.7kg/m to 32.4kg/m). Intraoperative data showed a lower incidence of complications in the BS-first group (0%) than in the IHR-group (13.7%), even after excluding emergency surgeries (P < .05). Postoperative morbidity was lower in the two-stage group, with intensive care unit admissions at 5.4% versus 17.5% and no mortalities. Median hospital stay was shorter (4.5 days vs. 7 days, P < .05). Three-year clinical recurrence was 8.3% versus 19.8%.

CONCLUSION

A two-stage approach may improve IHR outcomes by reducing recurrence, hospital stay, and postoperative morbidity and mortality. This approach should be considered if the patient is eligible for BS.