CONCURRENT LAPAROSCOPIC VENTRAL HERNIA REPAIR WITH BARIATRIC SURGERY: A PROPENSITY-MATCHED ANALYSIS OF THE METABOLIC AND BARIATRIC SURGERY ACCREDITATION AND QUALITY IMPROVEMENT PROGRAM (MBSAQIP) DATABASE
Jerry Dang*1, Muhammad Moolla2, Aryan Modasi1, Simon Byrns1, Noah Switzer1, Daniel W. Birch1, Shahzeer Karmali1
1Department of Surgery, University of Alberta, Edmonton, AB, Canada; 2Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
Background: Obesity is a contributing factor for primary and recurrent ventral hernias. During laparoscopic bariatric surgery, ventral hernias are often encountered. However, concurrent bariatric surgery with ventral hernia repair (VHR) remains controversial due to a higher risk of complications such as wound infections.
Aims: The objective of this study was to compare the rates of major 30-day complications and mortality in patients undergoing laparoscopic bariatric surgery with and without concurrent VHR. The secondary objective was to compare rates of wound infections between these approaches.
Methods: The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) collects data based on standardized definitions for preoperative, intraoperative and postoperative variables that are specific for metabolic and bariatric surgery. This data is collected from 832 centres in the United States and Canada and captures approximately 95% of procedures performed. Data were collected from the 2015 to 2017.
Patients undergoing laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) were included. Patients with previous bariatric surgery or undergoing an emergency procedure were excluded. Laparoscopic VHR was identified using Common Procedural Terminology codes 49652 to 49657. A propensity-matched analysis was performed between laparoscopic bariatric surgery with and without concurrent VHR. Propensity scores were based on preoperative comorbidities and bariatric procedure.
Results: A total of 430,225 patients were included, of which 4,690 (1.1%) received concurrent VHR. The mean age was 48.9 (SD 11.6) years, 74.2% were female and mean body mass index was 46.1 (SD 8.4) kg/m2. With one-to-one propensity score matching, 4648 pairs were selected. Analysis revealed that bariatric surgery with VHR was associated with a higher major 30-day complication rate (5.8 vs 3.8%, p< 0.001) with no significant difference in mortality (0.3 vs 0.2%, p = 0.531). Both LSG with VHR (3.2 vs 2.4%, p = 0.007) and RYGB with VHR (9.3 vs 5.7%, p < 0.001) were associated with a higher rate of major complications.
Rates of superficial surgical site infections (SSI) were similar between cohorts (0.7% vs 0.8%, p = 0.631). However, rates of deep SSI were higher in the VHR cohort compared to bariatric surgery alone (0.7 vs 0.3%, p = 0.025).
Conclusions: Patients undergoing VHR during bariatric surgery do not experience higher mortality. However, these patients have an elevated risk of major complications with this risk being higher among patients undergoing concurrent VHR and LRYGB. Furthermore, rates of deep SSI were two-fold higher in patients undergoing concurrent surgery. Bariatric surgeons should take these risks into consideration when choosing to perform VHR at the time of bariatric surgery.
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