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Obesity and Ventral Hernia Repair: Is There Success in Staging?

Introduction: Obesity predisposes patients to the development of abdominal wall hernias. Ventral hernia incidence, size, and recurrence rate are all increased in this population. As such, the surgeon is likely to encounter patients presenting for metabolic and bariatric surgery with existing ventral hernias. Controversy persists regarding the algorithm for treatment in this situation. Do we wait to repair, or is the weight inconsequential? Materials and Methods: We critically reviewed the available literature accessed through PubMed on the repair of ventral hernias in the obese population. Specifically, we focused on the outcomes after staged repair versus concurrent repair at the time of bariatric surgery. We aim at providing an overview of the conclusions from past and present publications with commentary by the authors. Results: A review of the literature finds conflicting opinions regarding the safety and success of concurrent ventral hernia repair at the time of bariatric surgery. Obese patients frequently have complex hernias and are predisposed to poor wound healing and increased recurrence. Although some small studies find success with concurrent repair, large registry analyses as well as expert consensus statements advocate for staged repair. Conclusion: For the obese patient with large ventral hernia, the authors recommend a staged approach, beginning with bariatric surgery and deferring the hernia repair until significant weight loss is obtained. The exception exists, and each patient must be evaluated critically regarding hernia size, contents, and risk of obstruction if left untreated.