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August 1, 2007

Autologous Tissue Reconstruction of Ventral Hernias in Morbidly Obese Patients

Author Affiliations

Author Affiliations: Divisions of Plastic and Reconstructive Surgery (Drs Chang, Foster, and Hansen and Ms Jazayeri) and General Surgery (Dr Patti), Department of Surgery, University of California, San Francisco.

Arch Surg. 2007;142(8):746-751. doi:10.1001/archsurg.142.8.746

Hypothesis  Separation of components is a safe and effective technique for abdominal wall reconstruction in morbidly obese patients.

Design  Review of a prospectively accumulated database.

Setting  University tertiary care medical center.

Patients  Thirty morbidly obese patients who underwent ventral hernia repair using the separation of components technique between August 1, 2001, and August 31, 2005.

Intervention  Ventral hernia repair using the separation of components technique.

Main Outcome Measures  Postoperative complications and hernia recurrence.

Results  Thirty morbidly obese patients (mean body mass index [calculated as weight in kilograms divided by height in meters squared], 61; range, 35-93) underwent ventral hernia repair by the separation of components technique (mean width of defect, 12.8 cm; mean length, 17.6 cm). Twenty-five patients (83%) had comorbidities. Twelve (40%) had undergone previous repairs (9 had undergone multiple repairs; mean, 2.4 repairs per patient; range, 2-4 repairs) and 6 (20%) had infected mesh. Sixteen patients (53%) underwent simultaneous panniculectomies and 6 (20%) underwent simultaneous bariatric procedures (Roux-en-Y gastric bypass). Postoperatively, cellulitis developed in 2 patients (7%), which was treated with antibiotics; wound infections occurred in 2 patients (7%), which were managed with local wound care; and a seroma developed in 1 patient (3%), which resolved spontaneously. The lone recurrent hernia (3%) was repaired with mesh. The mean length of follow-up was 44 months.

Conclusions  These results show that (1) separation of components is a safe and effective technique for repairing primary and recurrent ventral hernias in morbidly obese patients; (2) performance of a simultaneous panniculectomy or bariatric procedure does not affect the outcome; and (3) comorbidities do not compromise the results.