Staged versus concurrent ventral hernia repair with metabolic bariatric surgery: a systematic review and meta-analysis of comparative studies.

Abstract

<h4>Introduction</h4>This study compares the outcomes of concurrent metabolic bariatric surgery (MBS) and ventral hernia repair (VHR) vs. staged VHR approach after MBS.<h4>Method</h4>We systematically searched four main databases with relevant keywords. Two independent authors screened and included studies that compared these two approaches. The I² statistic was utilized to evaluate heterogeneity among the studies; if exceeded 50%, a random effects analysis was conducted, while fixed effects analysis was employed for those without severe heterogeneity.<h4>Results</h4>7 studies with 9244 and 11,961 patients in concurrent and staged groups were included, respectively. Our results showed that the rate of mesh infection was significantly higher in concurrent VHR (3.6% vs. 1.9%, OR: 2.18, p < 0.001), and mortality was insignificantly lower in staged VHR (0.3% vs. 0.1%, OR: 1.70, p = 0.09). Although surgical site infection, seroma, bowel obstruction, hernia recurrence, and reoperation were higher in the staged group, comparisons were statistically insignificant (all p > 0.05). Furthermore, hematoma, venous thromboembolic events, and wound dehiscence had nearly the same rates.<h4>Conclusion</h4>Both approaches are viable options, depending on individual patient circumstances (age, BMI, hernia size, hernia-related symptoms, sac with or without intestinal loops) and surgical preferences (type of MBS, with or without mesh, type of mesh) highlighting the importance of individualized surgical planning for optimization of outcomes and minimizing risks in this specific patient population.<h4>Registration</h4>The protocol of this study was submitted to PROSPERO and received the registration code CRD42023444310.