Background: Ventral abdominal hernias represent a frequent and often complicated clinical problem, especially in obese patients. Obesity has long been considered a risk factor for the development of primary and incisional ventral hernias.
Aim of Work: This prospective study aimed to evaluate efficacy and safety of laparoscopic approach in the treatment of ventral hernias in obese and morbid obese patients.
Patients & Methods: From May 2004 through June 2007, a total of 27 patients with body mass index (BMI) >30 kg/m2 assigned for laparoscopic ventral hernias repair (LVHR) were enrolled in the study. Patients' demographic and anthropometric data, fitness for surgery as judged by American Society of Anesthesiologists’ (ASA) score, number of previous abdominal operations and hernia repairs, size of fascial defect, size of mesh, operating time, operative blood loss, postoperative pain and use of postoperative analgesia, duration till resumption of oral intake, length of hospitalization and postoperative complications were recorded.
Results: The study included 27 patients, 15 patients had BMI35 (Group MO). Obese patients showed significant increase of the frequency of lower ASA grades compared to MO group with a significant frequency in co-morbidities in MO group compared to obese group. LVHR was completed successfully in 26 patients (96.3%), only one obese patient had dense adhesions that hampered sac dissection and was converted to open repair with a conversion rate of 3.7%. Concomitant surgical procedures were required in 9 patients. LVHR in MO patients consumed significantly longer operative time but non-significantly higher amount of intraoperative blood loss compared to O group. The frequency of pain sensation during rest showed non-significant difference between both groups. Obese patients resumed oral intake significantly earlier with significantly shorter length of hospital stay compared to group MO. There was a significant increase of postoperative surgical morbidities in MO group compared to O group. Mean follow-up period was 20.1±7.1; range: 7-34 months, 3 cases; 2 in MO group and one in O group had recurrent hernia with a total recurrence rate of 11.1%. There was a positive significant correlation between recurrence and facial defect size and mesh size and a positive non-significant correlation with BMI. Using ROC curve analysis for the specific predictors of high possibility of postoperative recurrence defined the mesh size as the highest specific predictor with AUC=0.889, followed by facial defect size with AUC=0.868 and BMI with AUC=0.722.
Conclusions: LVHR is a feasible, safe and effective approach for patients with BMI ≥30 LVHR in MO patients was associated with increased frequency of postoperative complication, delay of oral resumption and longer hospital stay, so preoperative reduction of body weight was recommended so as to improve its outcome in such high risk group of patients
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