Month: July 2016
“After Ventral Hernia Repair (VHR), complications are most likely to occur in patients with BMI ≥ 40 kg/m2. This subset of patients also had a significantly higher risk of undergoing surgery for a recurrent hernia, suggesting that this group of patients is likely to experience adverse outcomes after VHR and should be counseled to consider bariatric surgery prior to attempts at VHR.” Information on Bariatric Surgery here.
A hernia is present when part of an internal organ or tissue bulges through a defect or weak area in the belly wall (fascia). The type of hernia you have depends on where it is and how it occurs. Ventral Hernias are named after the location in the body they occur. A ventral hernia is a bulging of the abdominal wall anteriorly. When the hernia is located at the site of a pervious surgical scar then it is called an incisional hernia. A hernia can occur at any location of the abdominal wall however. Further information regarding incisional hernia here.
A Ventral Hernia can develop due to straining, lifting or increased abdominal pressure and is a weakening of the abdominal wall. Usually fat and internal organs bulge outside the facsia that holds the internal organs within the abdominal cavity. This type of hernia can be asymptomatic or cause pain with pressure or exertion. If left untreated, they can become larger or become incarcerated requiring emergent surgical intervention. Dr. Ara Keshishian performs ventral hernia repairs using a laparoscopic technique that may or may not require mesh repair. Mesh is place behind the defect in the abdomonial wall and extends past the hernia edges. Mesh is used to re-enforce the abdominal wall and allowing the healing tissue to form a sturdy foundation to help prevent reoccurrence of the hernia. Videos of Ventral Hernia Repairs here.
There is a continuous desire for a “less invasive”, “easier” procedure for the treatment of obesity and its associated co-morbidities. We have been very clear when discussing the benefits and long term outcome of the procedures. Let’s remind ourselves that “less invasive” does not mean a better option. In almost all cases a less invasive weight loss surgery means less weight loss, lower incidence of resolution of co-morbidities, and in some cases higher complications rate. Have we forgotten the adjustable gastric banding that was advocated to be the cure all for all obesity? All we hear now are the complications, the long term sequel of the reflux, hiatal hernia, irreversible esophageal injury, in addition to inadequate weight loss or weight regain.
Unfortunately, the same is to be said about the Sleeve Gastrectomy. We have said, as supported by the scientific literature, that the long term outcome of the sleeve gastrectomy is not as good as that of the Duodenal Switch procedure. This is true for the amount of weight loss as well as the resolution of the co-morbidities. We see quite a few patients who have gained their weight back after sleeve, never lost enough weight, and/or did not achieve resolution of their co-morbidities, such as diabetes, and are having their procedure revised to Duodenal Switch procedure.
Along with the same argument, this is why I caution patients when having the SIPS or SADI procedures. There is a chance that when the long term data for SIPS/SADI is available there may be some benefits procedure. However, as it stands at this point in time, these procedures are not the same as the Duodenal Switch procedure. So in short, less invasive, easier isn’t better.