Review of technique for combined closed incisional hernia repair and panniculectomy status post-open bariatric surgery.

Background: After open bariatric surgery, many patients develop incisional hernia. Patients who were once morbidly obese provide a unique challenge to hernia repair, given the larger nature of their fascial defects and the concomitant problem of extreme amounts of abdominal wall laxity. We reviewed a technique for surgical repair of incisional hernias combined with panniculectomy.

Methods: A retrospective review of 50 consecutive patients status post-open bariatric surgery who underwent incisional hernia repair with overlay mesh and combined panniculectomy between 2000 and 2003.

Results: Hernia repair and panniculectomy were performed 18 months after open bariatric surgery. The patients had an average weight loss of 58.6 kg. Mean follow-up after hernia repair and panniculectomy was 18 months. Patients underwent prefascial hernia repair with plication of the fascial edges followed by midline anchoring of overlay mesh. The averave amount of excess tissue excised via panniculectomy was 3,001 g. The average hospital stay was 4 days. Minor wound problems (eg, suture abscess, seroma) occurred in 20 patients. Seromas were treated with serial aspiration in the office. There were no intra-abdominal complications or recurrences of the incisional hernias.

Conclusion: Closed hernia repair with prefascial plication and overlay mesh is a safe, effective alternative to traditional incisional hernia repair. It provides adequate hernia repair without recurrence and eliminates intra-abdominal complications. It is our belief that combining the hernia repair and panniculectomy minimizes the risk of hernia recurrence through alleviation of stress on the repair by removing excess abdominal wall tissue.