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Morbid obesity, hernia repair

Mohammed Saif Sait, Robin Som, Cynthia Michelle Borg, Avril Chang, Sasindran Ramar
A best evidence topic has been constructed using a described protocol. The three-part question addressed was: In morbidly obese patients undergoing bariatric surgery, when a ventral hernia is picked up in clinic or intraoperatively is concurrent repair of the hernia better than delayed repair after weight loss with regards to complication rates? Using the reported search, 179 papers were found. 5 studies were deemed to be suitable to answer the question. All 5 studies assessed were non randomised studies either retrospective or prospective and the overall quality of these studies was poor...
November 2016: Annals of Medicine and Surgery
Anthony Gonzalez, Ernesto Escobar, Rey Romero, Gail Walker, Jacqueline Mejias, Michelle Gallas, Eugene Dickens, Christopher J Johnson, Jorge Rabaza, Omar Yusef Kudsi
BACKGROUND: The open approach continues to be widely performed for ventral hernia repair, while the minimally invasive laparoscopic approach has grown adoption over the last decade. Recently, robotic operation was described as a new modality due to the ease for performing intracorporeal closure of the hernia defect. This study is one of the first multi-institutional case series evaluating robotic-assisted laparoscopic ventral hernia repairs, with the goal of describing robotic-assisted surgical techniques for ventral and incisional hernia repair and the outcomes in teaching and community hospital settings...
August 5, 2016: Surgical Endoscopy
Dvir Froylich, Ivy N Haskins, Ali Aminian, Colin P O'Rourke, Zhamak Khorgami, Mena Boules, Gautam Sharma, Stacy A Brethauer, Phillip R Schauer, Michael J Rosen
INTRODUCTION: The laparoscopic approach to inguinal hernia repair (IHR) has proven beneficial in reducing postoperative pain and facilitating earlier return to normal activity. Except for indications such as recurrent or bilateral inguinal hernias, there remains a paucity of data that specifically identities patient populations that would benefit most from the laparoscopic approach to IHR. Nevertheless, previous experience has shown that obese patients have increased wound morbidity following open surgical procedures...
July 21, 2016: Surgical Endoscopy
Ashley D Willoughby, Robert B Lim, Michael B Lustik
OBJECTIVES: Open inguinal hernia repair is felt to be a less expensive operation than a laparoscopic one. Performing open repair on patients with an obese body mass index (BMI) results in longer operative times, longer hospital stay, and complications that will potentially impose higher cost to the facility and patient. This study aims to define the ideal BMI at which a laparoscopic inguinal hernia repair will be advantageous over open inguinal hernia repair. METHODS: The NSQIP database was analyzed for (n = 64,501) complications, mortality, and operating time for open and laparoscopic inguinal hernia repairs during the time period from 2005 to 2012...
May 18, 2016: Surgical Endoscopy
Jessica L Reynolds, Joerg Zehetner, Sharon Shiraga, John C Lipham, Namir Katkhouda
BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) has emerged as an effective weight-loss procedure for morbid obesity that is also effective for treating comorbidities such as diabetes. However, it has been associated with the development of GERD postoperatively. The pathophysiology of post-LSG GERD is unknown, and current studies have shown conflicting results. The aim of our study is to shed light on this issue by investigating the effect of LSG on the lower esophageal sphincter (LES) function and the relationship of LES function to GERD symptoms...
April 12, 2016: Surgical Endoscopy
E S Allam, D Y Johnson, S G Grewal, F E Johnson
INTRODUCTION: An aberrant course of the distal ureter can pose a risk of ureteral injury during surgery for inguinal hernia repair and other groin operations. In a recent case series of inguinoscrotal hernation of the ureter, we found that each affected ureter was markedly anterior to the psoas muscle at its mid-point on abdominal CT. We hypothesized that this abnormality in the abdominal course of the ureter would predict the potentially hazardous aberrant course of the distal ureter...
2016: International Journal of Surgery Case Reports
Arie P Dosoretz, James B Yu
The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors' suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice...
May 20, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
Mike K Liang, Julie L Holihan, Kamal Itani, Zeinab M Alawadi, Juan R Flores Gonzalez, Erik P Askenasy, Conrad Ballecer, Hui Sen Chong, Matthew I Goldblatt, Jacob A Greenberg, John A Harvin, Jerrod N Keith, Robert G Martindale, Sean Orenstein, Bryan Richmond, John Scott Roth, Paul Szotek, Shirin Towfigh, Shawn Tsuda, Khashayar Vaziri, David H Berger
OBJECTIVE: To achieve consensus on the best practices in the management of ventral hernias (VH). BACKGROUND: Management patterns for VH are heterogeneous, often with little supporting evidence or correlation with existing evidence. METHODS: A systematic review identified the highest level of evidence available for each topic. A panel of expert hernia-surgeons was assembled. Email questionnaires, evidence review, panel discussion, and iterative voting was performed...
March 15, 2016: Annals of Surgery
Palanivelu Praveenraj, Rachel M Gomes, Saravana Kumar, Palanisamy Senthilnathan, Ramakrishnan Parthasarathi, Subbiah Rajapandian, Chinnusamy Palanivelu
BACKGROUND: Roux-en-Y gastric bypass (RYGB) may be a better option for morbidly obese patients with gastroesophageal reflux (GERD) for long-term reflux control. It is recommended after fundoplication if a patient is morbidly obese with GERD with failed fundoplication or if bariatric surgery is planned with a prior successful fundoplication (Kim et al., Am Surg 80(7):696-703, 2014; Kambiz Zainabadi, Surg Endosc. 22(12):2737-40, 2008). Complete takedown of the wrap to avoid stapling over the fundoplication creating an obstructed, septated pouch is needed (Kambiz Zainabadi, Surg Endosc...
January 2016: Obesity Surgery
Matthew Davis, John Rodriguez, Kevin El-Hayek, Stacy Brethauer, Philip Schauer, Andrea Zelisko, Bipan Chand, Colin O'Rourke, Matthew Kroh
BACKGROUND AND OBJECTIVES: Treatment of gastroesophageal reflux disease (GERD) with hiatal hernia in obese patients has proven difficult, as studies demonstrate poor symptom control and high failure rates in this patient population. Recent data have shown that incorporating weight loss procedures into the treatment of reflux may improve overall outcomes. METHODS: We retrospectively reviewed 28 obese and morbidly obese patients who presented from December 2007 through July 2013 with large or recurrent type 3 or 4 paraesophageal hernia...
July 2015: JSLS: Journal of the Society of Laparoendoscopic Surgeons
Palanivelu Praveenraj, Rachel Maria Gomes, Saravana Kumar, Palanisamy Senthilnathan, Ramakrishnan Parthasarathi, Subbiah Rajapandian, Chinnusamy Palanivelu
BACKGROUND AND AIMS: Repair of recurrent ventral hernias (RVHs) has a high failure rate more so in the presence of obesity. The chronic increase in intra-abdominal pressure (IAP) associated with obesity might, in part, be an important implicating factor that needs to be addressed in these patients. Laparoscopic ventral hernia repair (LVHR) done with concomitant bariatric surgery in morbidly obese patients with RVHs may avoid multiple failures. We report our preliminary experience in treating RVHs in morbidly obese patients with laparoscopic intra-peritoneal onlay mesh (IPOM) repair and concomitant bariatric surgery...
June 2016: Obesity Surgery
N Merali, R A R Almeida, A Hussain
INTRODUCTION: We present a case on conservative management of salvaging the mesh in an immunocompromised morbidly obese patient, who developed a synergistic gangrene infection following a primary open mesh repair of an incisional hernia. PRESENTATION OF CASE: Our patient presented with a surgical wound infection, comorbidities were Chronic Lymphoblastic Leukemia (CLL), Body Mass Index (BMI) of 50, hypertension and diet controlled type-2 diabetes. In surgery, wide necrotic wound debridement, early and repetitive wound drainages with the use of a large pore polypropylene mesh and a detailed surgical follow up was required...
2015: International Journal of Surgery Case Reports
Iswanto Sucandy, Dewi Chrestiana, Fernando Bonanni, Gintaras Antanavicius
BACKGROUND: Gastroesophageal reflux disease (GERD) is prevalent in morbidly obese patients, and its severity appears to correlate with body mass index (BMI). AIM: The aim of this study is to investigate the status of GERD after laparoscopic sleeve gastrectomy (LSG). MATERIALS AND METHODS: A prospectively maintained database of all the patients who underwent LSG from February 2008 to May 2011 was reviewed. RESULTS: A total of 131 patients were included...
May 2015: North American Journal of Medical Sciences
Ahmed AbdElgaffar Helal
BACKGROUND: Inguinal hernia repair is the most common operation performed by pediatric surgeons, and herniotomy through a groin incision is the gold standard. Recently minimal access surgery (MAS) has challenged this conventional surgery. At the moment, cosmesis became the target of all MAS especially in female. So, MAS techniques have developed to become more minimally invasive, from 3 to 2 and now single port technique. However, most recent emerging techniques show a tendency for simple extracorporeal suturing with subcutaneous knotting, which has many drawbacks...
September 2015: Journal of Pediatric Surgery
E Chelala, H Baraké, J Estievenart, M Dessily, F Charara, J L Allé
PURPOSE: This retrospective chart analysis reports and assesses the long-term (beyond 10 years) safety and efficiency of a single institution's experience in 1326 laparoscopic incisional and ventral hernia repairs (LIVHR), defending the principle of the suturing defect (augmentation repair concept) prior to laparoscopic reinforcement with a composite mesh (IPOM Plus). This study aims to prove the feasibility and validity of IPOM Plus repair, among other concepts, as a well-justified treatment of incisional or ventral hernias, rendering a good long-term outcome result...
February 2016: Hernia: the Journal of Hernias and Abdominal Wall Surgery
Dvir Froylich, Miriam Segal, Adam Weinstein, Kamal Hatib, Eitan Shiloni, David Hazzan
BACKGROUND: Ventral hernia repair in obese patients has a high perioperative morbidity and recurrence. The laparoscopic approach may reduce those rates. This study compares those outcomes following laparoscopic ventral hernia repair (LVHR) with the standard open approach (OVHR) in obese patients. METHODS: A retrospective review of patients with a BMI > 30 kg/m(2) that had undergone ventral hernia repair (VHR) between 2004 and 2012 was included. Demographics, perioperative complications and recurrence rates were compared between the two approaches...
February 2016: Surgical Endoscopy
Maher El Chaar, George Ezeji, Leonardo Claros, Maureen Miletics, Jill Stoltzfus
BACKGROUND: Laparoscopic sleeve gastrectomy (SG), while generally safe and efficacious, may be complicated by gastroesophageal reflux disease (GERD) symptoms as well as the need for hiatus hernia (HH) repair. Identification and management of HH during SG and the effect of HH repair on GERD-related symptoms following SG are controversial. OBJECTIVE: This study aimed to evaluate HH repair during SG in morbidly obese patients and its short-term effect on GERD-related symptoms and other clinical outcomes...
January 2016: Obesity Surgery
Lily Wang, Aurora D Pryor, Maria S Altieri, Jamie L Romeiser, Mark A Talamini, Laurie Shroyer, Dana A Telem
BACKGROUND: The increasing prevalence of obesity translates into a greater number of obese patients undergoing general surgery procedures. We questioned if increased awareness and recent prophylaxis guidelines impacted the incidence of venous thromboembolism (VTE) in the obese patients. METHODS: A total of 33,325 patients who underwent 4 common general surgery procedures from 2005 to 2009 were identified from the American College of Surgeons' National Surgical Quality Improvement Program database...
November 2015: American Journal of Surgery
Jie J Yao, Thai Pham, Ali El Mokdad, Sergio Huerta
BACKGROUND: Factors that determine recurrence and complications following primary tissue repair of umbilical hernias (UHs) and the approach to repair UHs in obese patients need further analysis. METHODS: A retrospective review of UH repair (UHR) conducted at our institution was undertaken. Patients were grouped by body mass index (BMI) and compared for recurrence and complications. Univariate and multivariate analyses were performed. RESULTS: In total, 199 patients (BMI 32...
January 2016: American Journal of Surgery
Tim Tollens, Halit Topal, Alexander Lucardie, Koen Vermeiren, Chris Aelvoet
BACKGROUND: Laparoscopic ventral hernia repair (LVHR) is a common procedure in abdominal surgery. Use of mesh has become the gold standard in the last decade because of significantly fewer recurrences. Subsequently, the attention shifted to reduce mesh related complications in the short- and long-term as well as to facilitate its handling and positioning. In continuation of our previous study, we conducted a final analysis about the use of the Ventralight™ ST hernia patch (Davol Inc, Subsidary of C...
May 2015: Surgical Technology International
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