Concurrent ventral hernia repair in patients undergoing laparoscopic bariatric surgery: a case-matched study using the National Surgical Quality Improvement Program Database.

Background: There is no consensus regarding the optimal management of ventral hernias encountered during bariatric surgery.

Objective: To compare early patient morbidity and mortality between those patients undergoing laparoscopic bariatric surgery only and those patients undergoing laparoscopic bariatric surgery with concomitant ventral hernia repair.

Methods: American College of Surgeons National Surgical Quality Improvement Program Database (NSQIP). Methods: All patients undergoing laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy from 2012-2013 were identified within the NSQIP database. Those patients undergoing concomitant ventral hernia repair were compared with patients undergoing bariatric surgery only using a 1:1 matched analysis. Primary outcomes of interest included differences in 30-day composite adverse events, unplanned 30-day reoperation, and unplanned 30-day readmission to the hospital.

Results: A total of 27,608 patients underwent laparoscopic bariatric surgery during the study period; 988 (3.6%) patients underwent concomitant ventral hernia repair. After 1:1 matching, 1976 patients were evaluated. In terms of 30-day patient morbidity, patients who underwent concomitant ventral hernia were significantly more likely to experience all primary outcomes of interest, including composite adverse events (P = .01), a higher rate of unplanned return to the operating room (P<.001), and a higher 30-day readmission rate (P = .01).

Conclusions: Although we were unable to assess specific hernia characteristics from the NSQIP database, patients who underwent concomitant ventral hernia repair with laparoscopic bariatric surgery experience increased 30-day morbidity. Optimal management of concurrent ventral hernias and timing of repair in bariatric surgical patients requires further investigation.