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Tesi etd-12272019-142005

Thesis type
Tesi di specializzazione (5 anni)
Role of Bariatric Surgery in Ventral Hernia Repair of Obese Patients: Retrospective Case-Control Study
Corso di studi
relatore Prof. Chiarugi, Massimo
correlatore Dott. Anselmino, Marco
Parole chiave
  • Bariatric Surgery
  • Ventral Hernia Repair
  • Obese Patients
Data inizio appello
Secretata d'ufficio
Data di rilascio
Riassunto analitico
Obesity is an important risk factor for the development of abdominal wall defects because of increased intraabdominal pressure and poor wound healing potential.
Ventral abdominal reconstruction in obese patients is a challenge for general and bariatric surgeons and it is characterised by high rates of surgical site occurrence (SSO) and high recurrence rate.
Obese patients with ventral hernia are frequently asked to lose weight before surgery, often with poor results.
We tested the hypothesis that bariatric surgery (BS) can be considered an effective treatment for significant weight loss before ventral hernia repair.
We retrospectively compared 2 groups of patients with morbid obesity in a case control study: patients who underwent BS before VHR (BS+VHR, case group) and patients without BS before VHR (noBS+VHR, control group).
Patient demographics characteristics included age, sex, BMI, smoking status, comorbidities, hernia characteristics, area of meshes, operative details.
There were a total of 176 patients who underwent ventral hernia repair during the study period. A total of 108 (61%) patients underwent bariatric surgery before VHR. 107(60%) patients were submitted to laparoscopic IPOM and 69 (40%) to open TAR technique. The mean follow-up was 49 months (range 3-111 months.)
Recurrence rate was respectively of 12 (11%) in the BS group and 4 (7%) in the noBS group with no statistical difference (P=0.24).
Stratifying for BMI loss (∆BMI=12) recurrence rate was 4 (6%) in the BS group with BMI loss>12 versus 12 (13%) in noBS+VHR with BMI loss<12 (P<0.009).
Total SSI and SSO were 24 (22%) in the BS group versus 12 in the noBS (17%) with no statistical difference (P= 0.46).
Stratifying for BMI loss (∆BMI=12) complication rate was 15 (22%) in the BS group with BMI loss>12 versus 21 (23%) in noBS+VHR with BMI loss<12 (P=0.67.
Greater complication rates were associated with Open Ventral Hernia Repair (OVHR), 32% OVHR versus 13% LVHR (P<0.05).
Recurrence Rate was higher in patients who underwent laparoscopic VHR (12%) versus patient who underwent open TAR technique (3%), with statistical significance (P<0.022).
Successful results after bariatric surgery for morbidly obese patients with ventral hernia is associated with a decreased recurrence rate without increasing morbidity.
LVHR is associated with greater recurrence rate but lower complication rate and lower days of hospitalization compared with OVHR.
Bariatric surgery should be considered in any patients with morbid obesity presenting ventral hernia but we need further studies to be conducted in the form of prospective randomized trials.