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Weight Loss Surgery as a Bridge to Complex Ventral Hernia Repair

Most patients with complex ventral hernias have a body mass index (BMI) greater than 35 and have undergone multiple prior hernia repair surgeries.

Ventral Hernia RepairAnn 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). Continue reading

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Case Summary of Patient with Multiple Abdominal Wall Hernias

PATIENT: 41 year-old woman, 5’ 7”, 335 pounds, BMI 52

PRESENTATION: multiple abdominal wall hernias

CO-MORBIDITIES INCLUDED: hypertension, systemic lupus erythematosus with glomerulonephritis, chronic kidney disease

MEDICATIONS: chronic steroid use

SURGICAL HISTORY: colostomy, ileostomy, two hernia repairs

TREATMENT: surgical weight loss prior to attempting abdominal wall reconstruction

OUTCOME: greater than 100 lb. weight loss, successful abdominal wall reconstruction (weight at time of repair: 215 lbs.)

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