Most patients with complex ventral hernias have a body mass index (BMI) greater than 35 and have undergone multiple prior hernia repair surgeries.
Ann M. Rogers, M.D., director of Penn State Hershey Surgical Weight Loss, says, “For morbidly obese patients with a complex ventral hernia, it is critical to have a frank discussion about the need for meaningful weight loss to achieve lasting hernia repair success. While this can be emotionally uncomfortable for physicians and patients, it is often a life-changing, possibly life-saving conversation. Typically, trying to achieve weight loss in such patients through diet and exercise alone fails 95 percent of the time.”
Since 2012, Rogers has partnered with Penn State Hershey Gastroenterology and Hepatology using bariatric surgery for weight loss as a bridge to ventral hernia repair in appropriately selected patients. Patients must achieve a BMI less than 40 to be eligible for hernia repair (BMI less than 35 with serious co-morbid conditions). To date, a total of five patients have successfully undergone sleeve gastrectomy followed by permanent ventral hernia repair. In one notable case, a woman weighing more than 300 pounds lost more than 100 pounds with a sleeve gastrectomy, and within a few months underwent a successful ventral hernia repair (Figure 1).
“The hernia repair weight guidelines create a high level of motivation for patients to lose weight in order to undergo repair,” explains Rogers. So far, 100 percent of the selected hernia repair patients have successfully completed a six-month bariatric surgical screening and education program required by most insurance companies. This contrasts with a 60 percent drop-out rate in non-hernia bariatric surgery patients. Rogers further explains, “To address any emergent repair needs, bowel obstructions may be fixed, and a biological mesh may be inserted temporarily until a permanent solution is in place.”
Bariatric surgery in hernia repair patients is technically challenging. Rogers notes, “These patients present with a complex abdominal wall with scar tissue and adhesions. Ports may need to be placed in non-routine locations. Additional ports are sometimes needed to mobilize fat and tissue and to clear space for stomach access.” There is also a higher risk of converting to an open procedure and concurrent risks of complications. Within six to eight months following sleeve gastrectomy, weight loss is usually sufficient to allow permanent hernia repair involving components separation without tension. A durable synthetic mesh to achieve lasting abdominal wall repair and closure may also be implanted during this time.
The Penn State Hershey Surgical Weight Loss team includes three bariatric surgeons and one abdominal wall reconstruction expert, three dietitians, a psychologist, a licensed practical nurse and a certified bariatric nurse practitioner. Rogers and her team have partnered with other therapeutic programs to help qualify patients for various surgeries that have a weight requirement, including cardiac surgery, heart and kidney transplantation, and orthopaedics for joint replacement.
Ann M. Rogers, M.D.
Professor of Surgery
Phone: 717-531-7039 | E-mail: firstname.lastname@example.org
Fellowship: Minimally Invasive Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
Residency: General Surgery, St. Luke’s-Roosevelt Hospital Center, New York, New York
Medical School: Cornell University Medical College, New York, New York