Laparoscopic ventral hernia repair in patients with obesity: should we be scared of body mass index?

• Published in: Surgical endoscopy Vol. 36; no. 3; pp. 2032 - 2041
• Main Authors: Maspero, Marianna, Bertoglio, Camillo Leonardo, Morini, Lorenzo, Alampi, Bruno, Mazzola, Michele, Girardi, Valerio, Zironda, Andrea, Barone, Gisella, Magistro, Carmelo, Ferrari, Giovanni
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-03-2022; Springer Nature B.V
• Subjects: Abdominal Surgery; Body Mass Index; Gastroenterology; Gynecology; Hepatology; Hernia, Ventral - complications; Hernia, Ventral - surgery; Hernias; Herniorrhaphy - adverse effects; Humans; Laparoscopy; Laparoscopy - adverse effects; Length of stay; Medicine; Medicine & Public Health; Obesity; Obesity - surgery; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Postoperative Complications - surgery; Proctology; Recurrence; Retrospective Studies; Surgery; Surgical Mesh; Obesity; Body mass index; Laparoscopic ventral hernia repair; Ventral hernia
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-021-08489-9

Background
Obesity is a risk factor for ventral hernia development and affects up to 60% of patients undergoing ventral hernia repair. It is also associated with a higher rate of surgical site occurrences and an increased risk of recurrence after ventral hernia repair, but data is lacking on the differences between obesity classes.
Methods
Between 2008 and 2018, 322 patients with obesity underwent laparoscopic ventral hernia repair in our department: class I
n
 = 231 (72%), II
n
 = 55 (17%), III
n
 = 36 (11%). We compared short and long-term outcomes between the three classes.
Results
Patients with class III obesity had a longer median length of hospital stay compared to I and II (5 days versus 4 days in the other groups,
p
 = 0.0006), but without differences in postoperative complications or surgical site occurrences. After a median follow up of 49 months, there were no significant differences in the incidence of seroma, recurrence, chronic pain, pseudorecurrence and port-site hernia. At multivariate analysis, risk factors for recurrence were presence of a lateral defect and previous hernia repair; risk factors for seroma were immunosuppression, defect > 15 cm and more than one previous hernia repair; the only risk factor for postoperative complications was chronic obstructive pulmonary disease.
Conclusion
Class III obesity is associated with longer length of hospital stay after laparoscopic ventral hernia repair, but without differences in postoperative complications and long-term outcomes compared with class I and class II obesity.