Concurrent ventral hernia repair in patients undergoing laparoscopic bariatric surgery: a case-matched study using the National Surgical Quality Improvement Program Database

Abstract

BackgroundThere is no consensus regarding the optimal management of ventral hernias encountered during bariatric surgery. ObjectivesTo compare early patient morbidity and mortality between those patients undergoing laparoscopic bariatric surgery only and those patients undergoing laparoscopic bariatric surgery with concomitant ventral hernia repair. SettingAmerican College of Surgeons National Surgical Quality Improvement Program Database (NSQIP). MethodsAll patients undergoing laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy from 2012–2013 were identified within the NSQIP database. Those patients undergoing concomitant ventral hernia repair were compared with patients undergoing bariatric surgery only using a 1:1 matched analysis. Primary outcomes of interest included differences in 30-day composite adverse events, unplanned 30-day reoperation, and unplanned 30-day readmission to the hospital. ResultsA total of 27,608 patients underwent laparoscopic bariatric surgery during the study period; 988 (3.6%) patients underwent concomitant ventral hernia repair. After 1:1 matching, 1976 patients were evaluated. In terms of 30-day patient morbidity, patients who underwent concomitant ventral hernia were significantly more likely to experience all primary outcomes of interest, including composite adverse events (P = .01), a higher rate of unplanned return to the operating room (P<.001), and a higher 30-day readmission rate (P = .01). ConclusionAlthough we were unable to assess specific hernia characteristics from the NSQIP database, patients who underwent concomitant ventral hernia repair with laparoscopic bariatric surgery experience increased 30-day morbidity. Optimal management of concurrent ventral hernias and timing of repair in bariatric surgical patients requires further investigation.