Loss of domain defects in obese patients

Ching Surg endoscopy 2008
Comparison of early outcomes
Recurrence is not influenced by obesity. Recurrence related to defect
to mesh size.

Conflicting data.
Some think recurrence rate higher in obese

Concept of end stage hernia.

Options
Open inlay or onlay
Stoppa
Component separation
Laparoscopic
Combined with bariatric procedure

Contraindicatipmd to laparoscopy:
Loss of domain
Vet large defect >20 cm
Past or present mesh infections
Contraindicatipmd to synthetic mesh
Skin changes over hernia sac
Need to remove old mesh

chang archives ofaurgery 2007. Autologous recontruction.
- compontent separation 3% recurrence rate.

Should ventral hernia repair be delayed in obese patients.
- attempted medical weight loss.
- bariatric procedures.
Not known at this time.

Eid. Surg endocopy. 2004.
Repair of ventral hernia in morbidly obese.
-primary repair high 22%
- biological mesh no recurrences at 1 year
- high rate of sbo if adhesiolysis performed in hernia sac.

Staged repair may improve outcomes
Obesity is a contraindication.

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