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Bypass and concomitant hernia repair is safe and feasible
According to researchers from Luton & Dunstable University Hospital NHS FT, Luton, UK, laparoscopic Roux-e-Y gastric bypass (LRYGB) and concomitant laparoscopic abdominal wall hernia repair (LAWHR) using a prosthetic mesh is safe and feasible. The study was presented at this year’s Annual Scientific Meeting of the British Obesity and Metabolic Surgery Society in Leamington Spa, UK, from 22–24 January.
Laparoscopic AWHR in obese patients is a recognised approach although there is lack of consensus regarding timing and method of repair for such hernias in patients who are going to have bariatric surgery. There is also some debate whether to use a prosthetic mesh for LRYGB procedures where the gastrointestinal tract is opened to perform multiple gastrointestinal anastomoses. However, there is a risk of small bowel obstruction in patients undergoing LRYGB with untreated ventral hernias.
Mr Vigyan Jain and colleagues retrospectively examined their database and identified 134 morbidly obese patients with an abdominal wall hernia. Eighty-four (62.7%) patients underwent LRYGB and concomitant LAWHR with prosthetic mesh from January 2007 to October 2013. All patients underwent regular follow-up and BMI, age, size of the hernia, length of hospital stay, mesh-related complications and time of recurrence of the hernias were recorded.
Fifty-six patients were female, the mean age was 49.7 years, mean preoperative BMI 51.5 and mean size of the hernia was 22.9cm2.
Three (3.6%) patients developed non-mesh related complications postoperatively (two leaks, and one bleeding). Laparotomy and mesh removal was required in one leak and on the bleeding patient and the other patient, who developed an early leak, was treated with laparoscopic wash-out and drainage without mesh removal.
Mean length of hospital stay was 3.9 days and there were no cases of mesh infection or early recurrence. Four out of 82 (4.9%) patients developed late recurrence of the hernia and required a reoperation. Mean time of recurrence after surgery was 13.2 months (range: 8-18 months).
“LRYGB and concomitant LAWHR using a prosthetic mesh is safe and feasible,” said Jain. “There were no cases of infection, or other mesh related complications, and an acceptable late recurrence rate. To our knowledge, this is the largest series of LRYGB and concomitant LAWHR with mesh reported in literature.”
Co-authors of the study were Carlo Nagliati, Marco Barreca, Durgesh Raje, Douglas Whitelaw and Periyathambi Jambulingam.