Concomitant Laparoscopic Ventral Hernia Repair with Bariatric Surgery: A Propensity-Matched Analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Database
Supervisor / Principle Investigator:
Dr. Shahzeer Karmali
Dr. Jerry T. Dang
Dr. Simon Byrns
Dr. Noah Switzer
Dr. Daniel W. Birch
MD Class of 2021
Background: Ventral hernias are a common finding during bariatric surgery, however, the risks and benefits of repair during surgery remain unclear.
Objectives: The objective of this study was to compare the rate of major complications and mortality in patients undergoing laparoscopic bariatric surgery with and without concurrent ventral hernia repair (VHR).
Setting: The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database which includes data from 832 centers in the United States and Canada.
Methods: Patients undergoing laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) were included. A propensity-matched analysis was performed between laparoscopic bariatric surgery with and without concurrent VHR. Primary outcomes for matched patients were compared by type of bariatric procedure.
Results: A total of 430,225 patients who underwent bariatric surgery from 2015 to 2017 were included, of which 4,690 (1.1%) received concomitant ventral hernia repair (VHR). With one-to-one propensity score matching, 4648 pairs were selected. Analysis revealed that bariatric surgery with VHR was associated with a higher major complication rate (5.8 vs 3.8%, p< 0.001) but 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 an elevated rate of major complications.
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. Bariatric surgeons should take these risks into consideration when choosing to perform VHR at the time of bariatric surgery.