A629 Laparoscopic Roux-En-Y Gastric Bypass and Repair of Type III Paraesophageal Hernia with Biosynthetic Mesh Reinforcement
Morbid obesity is associated with an increased rate of hiatal and paraesophageal hernias (PEH). Concomitant repair at the time of Roux-En-Y gastric bypass is technically feasible, safe, and lowers recurrence rates; however, the ideal operative management remains controversial. The use of reinforcing mesh may further lower recurrence rates in the bariatric patient population. The patient is a 49 year-old female with a history of morbid obesity (BMI 42) and long-standing reflux with dysphagia. Preoperative endoscopy was notable for esophagitis and a moderate-sized PEH.
This study was a retrospective review of a prospectively maintained hernia registry from the 1st of February 2019 to 29th of February 2020.Results353 ventral hernia repair cases were recorded of which 47% were incisional hernias and the remainder were primary hernias. The median age was 54 years with even distribution of males and females. Half of the patients were obese with a median BMI of 31 kg/m2. The private sector performed 190 cases (54%) and the public sector 163 cases (46%). The public sector had more current smokers undergoing elective repairs, 28% vs 15%,p = 0.01 and performed more emerg...
AbstractIntroductionHow best to treat a small (
Hiatal hernias are often repaired concurrently with bariatric surgery to reduce risk of GERD-related complications.
ConclusionsIn this study, staged mesh repair of complex abdominal wall hernias after bariatric surgery in morbidly obese patients was associated with acceptable morbidity and no hernia recurrences at approximately 1.5 year follow-up.
In the paper by Angrisani et al. , the authors tackle an important question, namely, what are the long-term outcomes regarding gastroesophageal reflux disease (GERD) in patients undergoing sleeve gastrectomy (SG)? Many surgeons consider GERD to be the Achilles’ heel of the SG, and it is one of the main reasons for conver sion of the SG to other procedures, such as the gastric bypass . The last International Consensus Conference on SG demonstrated>50% of surgeons considered GERD to be a relative contraindication to the SG, and also hiatal hernias (HH) should be repaired when encountered .
In the paper by Angrisani et al, the authors tackle an important question, namely; what are the long term outcomes regarding gastroesophageal reflux disease (GERD) in patients undergoing sleeve gastrectomy (SG) ? Many surgeons consider GERD to be the Achilles heel of the SG, and it is one of the main reasons for conversion of the SG to other procedures such as the gastric bypass . The last International Consensus Conference on SG demonstrated that over 50% of surgeons considered GERD to be a relative contrindication to the SG, and also that hiatal hernias (HH) should be repaired when encountered .
Smoking and obesity are well-known risk factors for surgical site infection, but it is unknown whether these factors influence outcomes after repair of small umbilical and epigastric hernias with defects ≤2 cm. The aim of this study was to evaluate whether smoking and obesity are associated with readmission, reoperation for complications, and recurrence rates after elective repair of small umbilical and epigastric hernias.
ConclusionGoni Moreno PPP is an effective procedure that allows a high rate of fascial closure. The population of patients requiring such procedures presents a high-risk profile for complications regarding demographics and associated diseases.
ConclusionA tailored approach is now employed and seen more so in hernia surgery and this fact is referred to and highlighted in the contemporaneous hernia guidelines published to date. In addition, with the increasing complexity of abdominal wall surgery, the number of procedures actually performed by trainees is no longer considered adequate to overcome any recognized learning curve. Therefore, to supplement general surgery training young surgeons should be offered a clinical fellowship to obtain an additional qualification as an abdominal wall surgeon and thus improve their clinical and operative experience under superv...
ConclusionRecent high-level literature recommends the use of mesh repair (flat mesh) in all patients with hernia width ≥ 1 cm. This evidence is limited to the use of flat mesh through an open approach. While AHSQC surgeons do offer mesh repair in the majority of cases, this is most commonly using a mesh patch, and is selective towards larger hernias and obese patients. Further research is required to evaluat e the safety of mesh patches, and a mesh repair should be offered to a young non-obese healthy patient, as they benefit similarly from the use of mesh.