Mesh Infection Research Articles

The Impact of Social Media on Public Perception and Litigation in Hernia Surgery Complications: A Narrative Review

Title: The Impact of Social Media on Public Perception and Litigation in Hernia Surgery Complications. Introduction: Social media significantly impacts public perception of healthcare, leading to increased litigation for complications after hernia surgery. Our research focused on terms like ‘inguinal hernia repair,’ ‘medico-legal,’ ‘informed consent,’ ‘litigation,’ ‘malpractice,’ ‘social media’, ‘mesh’, ‘Leistenbruch’, and OLG in Pubmed, Google Scholar, and Google. Results showed chronic postoperative pain as a common cause of malpractice claims, with ultrasound being a valuable diagnostic tool. Urological injuries account for a significant portion of complications after surgery. Mesh infection leads to hospital readmission, increased healthcare costs, and lawsuits. The quality of the consent process is crucial, and patient perceptions of mesh use influence their decision-making. Healthcare professionals must understand the impact of social media on public perception and provide comprehensive patient information for informed consent and satisfaction.

Epigastric Ventral Hernia Repair Through Vaginal Natural Orifice Transluminal Endoscopic Surgery.

Ventral hernia repair is a commonly performed operation and can be executed by open or laparoscopic approach. The search for even less invasive techniques continues. Natural orifice transluminal endoscopic surgery (NOTES) is a known method of minimally invasive surgery. We performed an epigastric ventral hernia repair through vaginal NOTES during a concurrent hysterectomy and bilateral salpingectomy. We used the access to do a synchronous hernia repair with mesh augmentation. The technique of repair was identical to the laparoscopic intraperitoneal onlay mesh repair (Lap. IPOM). We reported a sufficient hernia repair without intra-operative complications. Also, post-operatively, no problems were encountered. Follow-up after 4 weeks showed a good and strong hernia repair. The complaints of the patient were relieved. CT scan 10 months after operation showed no recurrence nor signs of mesh infection. Ventral hernia repair through vaginal NOTES can be considered a possible new and minimal invasive (scarless) technique for ventral hernia repair but further investigations on a larger scale are needed to confirm feasibility & safety.

Five-Year Outcomes from a Prospective Study on Safety and Efficacy of Phasix ST Mesh Use at the Hiatus During Paraesophageal Hernia Repair.

Laparoscopic paraesophageal hernia (PEH) repair has a high hernia recurrence rate. The aim of this study was to assess the 5-year hernia recurrence rate after PEH repair using a combination of bioresorbable mesh and advanced surgical techniques to address tension as needed in a prospective group of patients. In 2016, a prospective database was established for 50 patients undergoing primary, elective PEH repair with a new bioresorbable mesh (Phasix ST). Intraoperatively, tension was addressed with Collis gastroplasty and diaphragm relaxing incisions as needed. All 50 patients from the initial study were tracked and asked to return for objective follow-up. Recurrence was considered present for any hernia more than 2 cm in size. Objective follow-up was conducted in 27 of the original 50 (54%) patients at a median of 5.25 years after their PEH repair. Before the 5-year follow-up, 5 patients had a known recurrent hernia. Objective evaluation at 5 years identified an additional 3 recurrences, for a total recurrence rate of 25% (8 of 32 patients). The hernia recurrence rate in patients with a Collis gastroplasty was significantly lower than in those without a Collis (7% vs 54%, p = 0.008). Two patients underwent reoperation for hernia recurrence. No patient had a mesh infection or mesh erosion. The combination of Phasix ST Mesh and tension-reducing techniques during PEH repair led to a 25% hernia recurrence rate at 5 years. The addition of a Collis gastroplasty led to significantly fewer hernia recurrences and is indicative of the potential for esophageal shortening in many patients with a PEH. The long-term safety and efficacy of Phasix ST Mesh in combination with surgical technique for PEH repair is confirmed.

Utilizing Hysteroscopic Mesh Resection for Presacral Mesh Infection Following Sacrocolpopexy

Utilizing Hysteroscopic Mesh Resection for Presacral Mesh Infection Following Sacrocolpopexy

Robotic Pauli repair of parastomal hernia.

Robotic retro-muscular mesh repair of parastomal hernia (PH) is possible with transversus abdominis release. The aim of this study is to report mid-term results with this method. Patients who underwent surgery for PH were enrolled in a prospective study. Patients with concomitant midline hernia also underwent Rives repair. Polypropylene meshes with an absorbable buffer mesh were used in the retro-muscular pocket-except PTFE was chosen for inflammatory bowel disease patients. Follow-up was by telephone and physical examination and CT if suspicion of complication. Of the 56 included ostomy patients, 44 had colostomies, 10 had ileostomies, and two had urostomies. Thirty-nine percent had a concomitant hernia, and 25% had recurrent PH. The mean operating time without accessory repair was 156min (SD 37), and with accessory repairs 220min (SD 62). One bowel lesion and one vascular injury to the stoma occurred, prompting intraoperative stoma revision without postoperative morbidity. Postoperative complications ensued in 12 patients (23%). One patient had stoma necrosis after 3weeks and the stoma was relocated. One patient had a mesh infection, 3 patients temporary ileus, one patient hypovolemic renal failure, and two patients experienced a flare-up of their Crohn's Disease. One parastomal abscess was drained percutaneously. The median postoperative stay was 3days (1-21; mean 3.7days), and the readmission rate was 8.9%. The recurrence rate at mean and median 24months follow-up is 5.4%, two in ileostomy patients and one colostomy patient with unaltered bulging where CT shows a relatively large prolapse and recorded as a failure. Robotic Pauli repair has shown promising results. However, repair fails of PH at small bowel ostomies with short mesentery. ePauli/TAR is now the preliminary choice for eligible patients at our site. Comparative studies with the intraperitoneal mesh standard are needed.

Abdominal Mesh Colpopexy Without Promontory Fixation: 10-Year Follow-up Results of the Peritoneocolpopexy Technique

ObjectivesTo restore apical vaginal prolapse support when the access to the promontory is challenging, a modified method of colpopexy may be needed. We present our 10-year results on the peritoneocolpopexy (PCP) technique without promontory fixation relying on unidirectional barbed delayed absorbable sutures (V-Loc). MethodsFourteen women who underwent PCP for vaginal vault prolapse between 2011 and 2014 participated in an IRB-approved prospective study (11 non-infected; 3 with infected mesh needing excision). Ten-year follow-up data including validated questionnaires (UDI-6, IIQ-7, QoL), pelvic organ prolapse quantifications (POP-Q), complications, re-operations, and secondary prolapses were collected. Paired statistical analyses compared various timepoints and mixed model analysis assessed questionnaire and POP-Q trends over time. ResultsMedian follow-up was 9.7 years (IQR: 6.0 – 0.7) to last POP-Q and 10.4 years (IQR: 9.6 – 11.5) to last contact. No patients were lost to follow-up. Mean baseline C point for all patients was -4.3 and -2.9; 1-year C point was -9.1 and -9.2 and -8.6 and -8.5, respectively at last visit. POP-Q findings improved between pre-PCP and 1-year post surgery and did not significantly change until the last visit. Trends in UDI-6, IIQ-7, QoL and POP-Q findings showed no significant change in any category per year (95% CI, p = 0.2 – 0.9). Secondary anterior compartment prolapse was noted in 3 patients with 1 requiring a repair. ConclusionsPeritoneocolpopexy provides durable vaginal apical support when access to the promontory is compromised. PCP can also be used to prevent secondary prolapse after an infected mesh removal.

Continuing the Dialogue: A Response to a Commentary on "Outcomes of Immediate Multistage Abdominal Wall Reconstruction of Infected Mesh: Predictors of Surgical Site Complications and Hernia Recurrence".

Continuing the Dialogue: A Response to a Commentary on "Outcomes of Immediate Multistage Abdominal Wall Reconstruction of Infected Mesh: Predictors of Surgical Site Complications and Hernia Recurrence".

Open suture repair versus PermacolTM mesh repair of small ventral hernias in patients with end-stage kidney disease.

Ventral hernia is a common surgical problem among patients with end-stage kidney disease (ESKD), while the optimal repair technique for small ventral hernias is controversial. This study aimed to compare the outcomes of open suture repair versus biological mesh repair of small ventral hernias with defect size ≤2 cm in ESKD patients. Data from consecutive ESKD patients who underwent elective ventral hernia repair with defect size ≤2 cm at a single institution from January 2012 to January 2022 were retrospectively reviewed. Outcomes of open suture repair were compared to PermacolTM mesh repair. The primary outcome was recurrence rate. Secondary outcomes included post-operative complications, peri-operative and post-operative dialysis regimen. Forty-seven ventral hernia repairs were included, with 20 being suture repairs and 27 being PermacolTM mesh repairs. Median age at hernia repair was 60 (range 32-81) years old. Pre-operatively, 42 patients (89.4%) were on peritoneal dialysis (PD). Paraumbilical hernia (59.6%) was most common. Median hernia defect size was 15 mm (range 2-20 mm). Upon median follow-up of 56 (range 9-119) months, more patients in the suture repair group developed recurrence (30% vs. 0%, p = 0.004). Median time to recurrence was 10 (range 5-16) months. There was no wound or mesh infection. The majority of patients underwent intermittent PD peri-operatively and were able to resume on PD in the long run. Ventral hernia repair is indicated in ESKD patients even for small defects; repair with PermacolTM mesh was associated with a lower recurrence rate when compared to suture repair and post-operative morbidity was low.

Development and Validation of a Prognostic Model to Predict Late Seizures After Traumatic Brain Injury: A Retrospective Analysis.

Posttraumatic epilepsy (PTE) is considered to be one of the most severe and enduring outcomes that can arise from traumatic brain injury (TBI). The authors' study aims to create and authenticate a prognostic model for forecasting the PTE occurrence after TBI. The clinical prognostic model was developed in 475 people who had a TBI history in Nanning using a multivariate logistic regression model. The score in the authors' prognostic model participants was subjected to external validation from other cities in Guangxi and assessed its performance with the area under the receiver operating characteristic curve (area under the curve), calibration plots, and decision curve analysis. Six variables were selected to establish the nomogram for PTE, including time, Glasgow Coma Scale, location, cranial imaging (midline shift), intracranial infection, and titanium mesh cranioplasty. The area under the curve was found to be 0.860 in the training cohort and 0.735 in the validation cohort, revealing that the nomogram exhibited a satisfactory level of discriminative ability. The calibration plots exhibited a substantial degree of concordance between the prognostic predictions generated by the nomogram and the observed outcomes in both the training and validation groups. In addition, the decision curve analysis demonstrated the clinical utility of the nomogram. The cutoff value for the training cohort was determined to be 0.381, whereas for the validation cohort, it was 0.380. This suggests that patients with a probability >0.381 should be given special consideration. A prognostic nomogram was formulated and verified to aid health care clinicians in assessing the prognosis of patients with PTE.

72122 - Mesh removal due to foreign body reaction and mesh infection in Groin hernia surgery: A long-term nationwide population-based register study

72122 - Mesh removal due to foreign body reaction and mesh infection in Groin hernia surgery: A long-term nationwide population-based register study

Platelet-Rich Therapies in Hernia Repair: A Comprehensive Review of the Impact of Platelet Concentrates on Mesh Integration in Hernia Management.

Mesh-augmented hernia repair is the gold standard in abdominal wall and hiatal/diaphragmatic hernia management and ranks among the most common procedures performed by general surgeons. However, it is associated with a series of drawbacks, including recurrence, mesh infection, and adhesion formation. To address these weaknesses, numerous biomaterials have been investigated for mesh coating. Platelet-rich plasma (PRP) is an autologous agent that promotes tissue healing through numerous cytokines and growth factors. In addition, many reports highlight its contribution to better integration of different types of coated meshes, compared to conventional uncoated meshes. The use of PRP-coated meshes for hernia repair has been reported in the literature, but a review of technical aspects and outcomes is missing. The aim of this comprehensive review is to report the experimental studies investigating the synergistic use of PRP and mesh implants in hernia animal models. A comprehensive literature search was conducted across PubMed/Medline, Web of Science, and Scopus without chronological constraints. In total, fourteen experimental and three clinical studies have been included. Among experimental trials, synthetic, biologic, and composite meshes were used in four, nine, and one study, respectively. In synthetic meshes, PRP-coating leads to increased antioxidant levels and collaged deposition, reduced oxidative stress, and improved inflammatory response, while studies on biological meshes revealed increased neovascularization and tissue integration, reduced inflammation, adhesion severity, and mechanical failure rates. Finally, PRP-coating of composite meshes results in reduced adhesions and improved mechanical strength. Despite the abundance of preclinical data, there is a scarcity of clinical studies, mainly due to the absence of an established protocol regarding PRP preparation and application. To this point in time, PRP has been used as a coating agent for the repair of abdominal and diaphragmatic hernias, as well as for mesh fixation. Clinical application of conclusions drawn from experimental studies may lead to improved results in hernia repair.

Totally Extra Peritoneal Management of Inguinal Hernia Repair: Our Experience in a Public Sector Hospital

Objective: The study objective is to analyze the clinical effectiveness and efficiency of laparoscopic TEP in our set up and to determine its surgical outcomes regarding incidence of early and late post-operative complications. Materials and Methods: A retrospective descriptive study was conducted at Surgical Unit II, Benazir Bhutto Hospital, Rawalpindi Medical University for 5 years and 6 months from January 2018 to June 2023. After approval from the ethical board, data was collected as a qualitative research study through focus group interviews. Adult patients aged between 20 to 70 years, selected by retrospective consecutive sampling who were presented in surgical OPD with unilateral, bilateral, or recurrent inguinal hernia, underwent laparoscopic TEP hernia repair. Patients were reviewed on 1st post-operative day, during 1st week, and at 6 months to 1 year post-surgery. Data was entered into a standard SPSS sheet version 26. Results: The primary outcomes were evaluated based on early postoperative complications including wound infection, seromas or hematoma, urinary retention and abscess formation or mesh infection, and late complications including recurrence and chronic pain. Clear advantages were observed for the laparoscopic TEP technique regarding early return to normal daily activities due to reduced postoperative complications. Conclusions: The newer advanced concepts in hernia surgeries have proven to have good control over early complications, and postoperative pain, with minimal recurrence. Surgeons should acquire adequate experience and anatomical knowledge before performing this advanced inguinal repair surgery.

The benefits of preoperative smoking cessation on abdominal wall reconstruction outcomes: An examination of abstinent versus never smokers

IntroductionActive smoking is related to wound and respiratory complications following abdominal wall reconstruction (AWR), but no AWR studies directly compare outcomes of abstinent-smokers (AS), fulfilling four-weeks of smoking cessation, to non-smokers (NS). MethodsProspectively maintained institutional database was queried for all AWR between 2012 and 2019. AS and NS were included. Primary outcomes were wound and respiratory complications; secondary outcome was recurrence. Standard statistical analyses were performed. ResultsEvaluation included 1088 patients, 305 AS and 783 NS. AS had a lower BMI (31.3 vs 32.7 ​kg/m2; P ​= ​0.004) but increased ASA Class III (51.5% vs 34.5 ​%, P ​= ​0.009), COPD (8.9% vs 4.0 ​%, P ​= ​0.001), comorbidities (6.3 vs 4.7, P < 0.001), and wound class (Class III/IV: 25.3% vs 15.8 ​%, P ​= ​0.003). AS had increased defect size (229 vs 209.1 ​cm2; P ​= ​0.023), use of component separation (CST) (52.5% vs 43.8 ​%; P ​= ​0.010) and hospital stay (6.6 vs 6.2 days, P ​= ​0.015). Postoperative wound, mesh, and pulmonary infection, respiratory failure, and recurrence were similar.On multivariable regression, wound class and complications predicted recurrence. BMI, panniculectomy and CST predicted wound complications. BMI, CST, and wound class predicted respiratory complications. ConclusionDespite greater patient and hernia complexity, smoking cessation appears to result in similar outcomes to never-smokers in this AWR population.

Improvement in Quality of Life after Laparoscopic or Robotic-assisted Sacrocolpopexy with a Single Anterior Mesh in Patients with Pelvic Organ Prolapse: A Retrospective Analysis from a Single Institution.

Pelvic organ prolapse (POP) is a significant health-care problem for older women. We have treated POP surgically using laparoscopic sacrocolpopexy (LSC) or robotic-assisted sacrocolpopexy (RSC). The original LSC and RSC procedures were done with anterior and posterior meshes; however, the use of the single mesh procedure is increasing because of its simplicity and safety. There have been few reports about the change in quality of life (QOL) using the single mesh procedure. Therefore, the present study aimed to retrospectively evaluate the change in QOL by LSC and RSC using a single anterior mesh for women without posterior compartment prolapse. We performed LSC or RSC using a single anterior mesh in 52 patients who had POP without posterior vaginal wall prolapse between August 2018 and October 2022. We assessed the QOL before and after surgery using prolapse-QOL (P-QOL) questionnaires. All patients who received LSC or RSC with a single anterior mesh left the hospital as scheduled without severe perioperative complications. There were no instances of wound infection or vaginal mesh extrusion. The recovery rate of questionnaires was 63.5% (33/52). All QOL score domains improved significantly, and there were no questionnaire parameters that worsened. LSC or RSC using only a single anterior mesh improves P-QOL with a low incidence of surgical complications for POP patients who did not have posterior vaginal wall prolapse. LSC or RSC with a single anterior mesh may be a prospective new procedure for POP.

An unusual case of an isolated, incarcerated appendix epiploica inguinal hernia and laparoscopic mesh herniorrhaphy

Abstract An isolated appendix epiploica (AE) inguinal hernia remains a rare surgical entity despite laparoscopic herniorrhaphy and improved intra peritoneal visualization. The surgical disposition of the AE remains controversial with proponents for both excision and conservative management. The paucity of data, based only on case reports precludes definite guidelines in their management. The presence of infection, organ ischemia, surgeon experience, and biological mesh availability all play a role in the management of this type of hernia. We present a rare case report with a viable incarcerated, AE inguinal hernia and its laparoscopic excision, and hernia repair. This is only the third such case report in the published literature to date.

Expanded polytetrafluoroethylene mesh in chest-wall reconstruction: A 27-year experience

ObjectiveThe study objective was to evaluate the success of expanded polytetrafluoroethylene mesh in chest-wall reconstruction. MethodsWe retrospectively reviewed patients who underwent expanded polytetrafluoroethylene (Gore-Tex) chest-wall reconstruction. The main outcome was a mesh-related event, defined as a mesh-related reoperation (eg, mesh infection requiring debridement with/without explant, tumor recurrence with explant) or structural dehiscence/mesh loosening with/without a hernia. Demographics and surgical outcomes were reported. ResultsA total of 246 reconstructions met inclusion (1994-2021). Fifty-five reconstructions (22.4%) had mesh-related events within a median of 1.08 years (interquartile range, 0.08-4.53) postoperatively; those without had a stable chest for a median of 3.9 years (interquartile range, 1.59-8.23, P < .001). Forty-one meshes (16.6%) became infected, requiring reoperation. Eighty-eight percent (36/41) were completely explanted; 8.3% (3/36) required additional mesh placement. Predictors of mesh-related events were prior chest-wall radiation (odds ratio, 9.73, CI, 3.47-30.10, P < .001), higher body mass index (odds ratio, 1.08, CI, 1.01-1.16, P = .019), and larger defects (odds ratio, 1.48, CI, 1.02-2.17, P = .042). The risk of mesh-related events with obesity was higher with prior chest-wall radiation. ConclusionsMost patients (78%) with an expanded polytetrafluoroethylene mesh had a stable reconstruction after a median of 4 years. Obesity, larger defects, and prior chest-wall radiation were associated with a higher risk of a mesh-related event mostly due to mesh infections. Seventeen percent of reconstructions had reoperation for mesh infection; 88% were completely explanted. Only 8% required replacement mesh, suggesting that experienced surgeons can safely manage them without replacement. Future studies should compare various meshes for high-risk patients to help guide the optimal mesh selection.

Polypropylene Mesh Infection From Surgical Site Infections Caused by Mycobacterium fortuitum

Polypropylene Mesh Infection From Surgical Site Infections Caused by Mycobacterium fortuitum

THE IMPACT OF A CLOSING PROTOCOL (CP) IMPLEMENTATION ON WOUND MORBIDITY IN ABDOMINAL WALL RECONSTRUCTION (AWR) WITH MESH

Abstract Background Wound complications (WC) are associated with increased cost, recurrence, and mesh infection. Operative CPs have not been evaluated in AWR. Our aim was to evaluate the effect of a CP on wound infection (WI) and WC. Method A prospective, institutional database was used to compare AWR with and without CP. Descriptive statistics and a Bayesian Structured time series analysis (BSTA) were performed to evaluate rates of WI and WC. Data is reported as means unless stated. The CP involves antibiotic wound irrigation, glove and instrument exchange, re-draping the field, surgeon-only handling the mesh prior to mesh implantation. The introduction of on-going quality improvement efforts were accounted for in the model. Results A total of 2541 patients were examined with an age of 57.9 ± 12.6 years, 56.7% female, BMI 32.9 ± 9.8 kg/m2, 24.2% diabetic, and 41.2% former-smokers. Defect size was 203.1 ± 205.8 cm2 and 83.1% were CDC Class 1 or 2 wounds. Follow-up was 31.5 ± 41.4 months. Overall WI and WC rate decreased after CP (14.5% vs. 2.6% and 29.3% vs. 10.3%, P &amp;lt; 0.001). Specifically, the rate of wound cellulitis (9.7% vs. 2.7%, P &amp;lt; 0.001), wound infection (13.8 vs. 1.8%, P &amp;lt; 0.001), and mesh infection (2.1% vs. 0.6%, P &amp;lt; 0.004) were reduced after CP. For WI, BSTA revealed a relative effect of 83% (±2%, 95%CI:-87%,-78%; P = 0.0002) reduction compared to counterfactual. For WC, the BSTA revealed a relative effect reduction compared to counterfactual of 67% (±3%, 95%CI:-60%, -72%; P = 0.0002). Conclusion Introduction of a CP prior to mesh implantation in open AWR led to a significant reduction in overall wound infections and wound complications. The use of a CP should be strongly considered.

A CHALLENGING CASE OF MANAGEMENT OF AN INFECTED MESH WITH LAPAROSCOPY, ADHESIOLYSIS AND REMOVAL OF THE MESH

Abstract Aim To present a challenging case of an infected mesh in an obese patient managed with a combination of laparoscopy and open incision. Material and Methods An 57-year-old woman with diabetes type 2, obstructive sleep apnoea requiring Continued Positive Airway Pressure (CPAP) and a BMI of 43 presented to be seen in the outpatient clinic. Her visits were related to a infected mesh in her right upper quadrant of the abdomen as a result of a laparoscopic repair of incisional hernia post open cholecystectomy 13 years ago. The CT scan confirmed an infected mesh. A laparoscopy approach was used initially. Insufflation: Optic trocar COz 17 mmHg (left paramedian line). Ports: Leftt 10 mm, 2 × 5 mm LUQ and lower epigastric (midline). Findings: Laparoscopy: Adhesions of the omentum with the anterior abdominal wall, Cirrhotic liver, hepatic flexure below the area of the infected mesh but without any obvious colonic fistula. Open incision for fistulectomy: Long thick tract leading to preperitoneal space. Large cavity containing an infected mesh 15 × 15 polypropylene mesh. Metallic tacks present in the cavity. Procedure Adhesiolysis. Findings as above. Simultaneously laparoscopy and open exploration of the area of the fistula was performed with a surgeon on each side. Fistula was removed intact. A preperitoneal cavity was found which was the source of infection. Mesh was removed intact with tacks on. Sent for micro. Very good wash of the cavity with betadine. Exploration laparoscopically. Hepatic flexure was below the area of the infected mesh. As there was a suspicious area which might corresponded to a colonic fistula, further adhesiolysis was performed. The hepatic flexure was mobilised making sure that there was no bowel involvement. In order to maintain bowel wall and avoid injury, an area of the peritoneum was left on the bowel. Right colon was checked for injury – negative. Peritoneal defect was closed with 1 prolene (× 2) interrupted sutures with endoclose device. A 30 Fr Robinson's drain was left in the Rt paracolic gutter via the lower 5 mm port. Exsuflation of COz, extraction of trocars. Closure of the anterior abdominal wall with J PDS interrupted. 14Fr Redivas in the subcutaneous tissue. Results The patient's postoperative course was uneventful. She was discharged the 5th post operative day. At 3 months follow-up the patient is well and asymptomatic with a small induration of the skin in the area of the previous infection. Conclusion Mesh infection is a devastating complication. A surgeon with an interest and experience in abdominal wall surgery can offer a safe and efficient approach to these cases.

OBESITY AND HERNIA – ALGORITHM AND EVIDENCE

Abstract Materials and Method Obesity with abdominal wall hernia is always a concern for the patient and surgeon. BMI is an inflammatory state and very high risk of recurrence, surgical site infection, or Subacute Obstruction, if we decide to do Metabolic surgery and Hernia together or defer the Hernia surgery. IPOM Plus was done with dual mesh with three port technique by Laparoscopy or Robotic for Hernia and Sleeve Gastrectomy Conclusion We compared our data and found that Hernia repair and Metabolic surgery can be done in the same sitting with favourable hernia and favourable obesity. Data Concomitant Bariatric with Hernia repair. (January 2008 to December 2021). Total number of patients: 21. BMI: 46.26 +/- 6.6. No. of Sleeve Gastrectomy: 19/ IPOM/ No Recurrence/ No SSI. No. of Gastric Bypass: 1/ PR/ No Recurrence. No. of MGB: 1/ PR/ 3 years later IPOM + Repair. Mean hospital stay: 2.5 days. No. of Post op Mesh infections: 0.