Concomitant bariatric surgery and hernia repair: A Data-Driven answer to a longstanding surgical dilemma.

Abstract

<h4>Objective</h4>To evaluate the safety, efficacy, and long-term outcomes of concomitant laparoscopic bariatric surgery and ventral hernia repair in obese patients. Obesity and ventral hernia frequently coexist, often presenting a surgical dilemma. Historically, concerns over mesh infections, extended operative time, and increased morbidity have led to a preference for staged procedures. However, with advancements in laparoscopic techniques and increasing evidence supporting mesh placement in clean-contaminated fields, the concomitant approach has gained acceptance. High-quality data from large-volume centers remain limited till now.<h4>Method</h4>This retrospective study was conducted at a tertiary care center between January 2003 and December 2023. A total of 353 patients underwent simultaneous bariatric surgery-either laparoscopic sleeve gastrectomy (LSG), Roux-en-Y gastric bypass (LRYGB), or mini-gastric bypass (MGB-OAGB)-with ventral hernia repair using intraperitoneal onlay mesh (IPOM), eTEP-Ventral RS, or eTEP-TAR techniques. The Primary objective of the study was to assess the complication and recurrence rates. Secondary objective included operative time, hospital stay, and postoperative recovery.<h4>Results</h4>Of the 353 patients, 224 underwent LSG, 74 LRYGB, and 55 MGB-OAGB. IPOM was used in 90% of cases. The overall complication rate was low, with seroma (2.3%), ileus (2.6%), hematoma (1.1%) and Surgical site occurrences (SSO) (3.4%) being the most common. No mesh infections or anastomotic leaks were observed. Mean operative time ranged from 124 to 167 min, and average hospital stay was 3.1 ± 1.1 days. At one-year follow-up in 268 patients (80%), hernia recurrence was 0.6%.<h4>Conclusions</h4>Concomitant laparoscopic bariatric surgery with hernia repair is a safe and effective option in appropriately selected patients, with excellent outcomes and minimal complications.