Background

Repair options for ventral hernias in patients with obesity include performing bariatric surgery prior to definitive hernia repair or a concomitant approach. The aim of this study is to perform a meta-analysis to determine which surgical approach is best for bariatric patients with hernias.

Methods

A PRISMA literature search in PubMed using keywords noted in Figure 1 was performed. We screened for all retrospective and prospective studies that focused on outcomes of patients who underwent both hernia repair and bariatric surgery, either simultaneously or separately. Exclusion criteria included studies pertaining to hiatal and inguinal hernia repair, as well as case reports and case series.

Results

Seven comparative studies, resulting in a total of 6,331 “staged” patients (weight loss surgery followed by hernia repair) and 1,820 “concomitant” patients were included. For the comparative studies (Table 1), the concomitant approach was associated with decreased odds of experiencing SSI, reoperation, and seroma formation at any time. The staged approach was associated with decreased odds of mesh infection in the first 30 days after surgery. Data was insignificant for bowel complications in the comparative studies. Figure 1 demonstrates the PRISMA diagram for study inclusion and exclusion.

Conclusions

There is insufficient evidence to determine if a concomitant repair or a staged approach is best due to a lack of data in regards to hernia size and reported outcomes. However, the data suggests the staged approach is more appropriate if the hernia requires the placement of mesh.