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Background <p>Incisional hernia (IH) repair in morbidly obese (MO) patients poses significant challenges due to higher risks of complications and recurrence. Traditional open repairs are linked to increased morbidity, driving interest in minimally invasive techniques. The enhanced view totally extra-peritoneal Rives-Stoppa (eTEP-RS) technique shows promise as a laparoscopic method for IH repair, but data on its efficacy and safety in MO patients are limited. This study aims to evaluate the efficacy, safety, and feasibility of the eTEP-RS approach specifically for IH repair in this high-risk population.</p> Methods <p>Analysis of a retrospective cohort of consecutive patients undergoing laparoscopic eTEP-RS for IH repair between 2017 and 2022 which included 135 patients, categorized into two groups based on body mass index (BMI): the MO group (BMI &gt; 35&#xa0;kg/m<sup>2</sup>) and the control group (BMI ≤ 35&#xa0;kg/m<sup>2</sup>). We compared demographics, comorbidities, hernia characteristics, intra-operative data, post-operative outcomes, and hernia recurrence rates.</p> Results <p>Patients in the MO group had significantly more type 2 diabetes mellitus (<i>n</i> = 18, 51% vs <i>n</i> = 25, 25%; <i>p</i> = 0.004), hypertension (<i>n</i> = 35, 73% vs <i>n</i> = 75, 53%;<i> p</i> = 0.017), dyslipidemia (<i>n</i> = 29, 60% vs <i>n</i> = 58, 41%; <i>p</i> = 0.021), ASA score 3 (<i>n</i> = 18, 52% vs <i>n</i> = 23, 23%; <i>p</i> = 0.004), a history of previous umbilical hernia repair (<i>n</i> = 13, 27% vs <i>n</i> = 13, 9.2%; <i>p</i> = 0.002), and bariatric surgery (<i>n</i> = 10, 29% vs <i>n</i> = 13, 13%; <i>p</i> = 0.035). There were no differences in intra-operative characteristics, operative times, or intra-operative complications between groups. During a median follow-up period of 1&#xa0;year (IQR 40–680&#xa0;days), there were no differences in hernia recurrence (<i>n</i> = 2, 5.7% vs <i>n</i> = 9, 9%; <i>p</i> = 0.07), time to recurrence, or chronic analgesia usage between groups.</p> Conclusion <p>The laparoscopic eTEP-RS approach was safe and effective for IH repair in patients with MO, demonstrating comparable post-operative outcomes and recurrence rates to those with a lower BMI in a selected cohort of patients.</p>

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A retrospective cohort study of laparoscopic enhanced view totally extra-peritoneal Rives-Stoppa (eTEP-RS) repair of incisional ventral hernias in patients with morbid obesity

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  • 发表日期：

    2025年2月3日

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  • Shlomi Rayman,
  • Mohamad Molham,
  • Ran Orgad,
  • Hana Gelman,
  • Eliyahu Gorgov,
  • Youri Mnouskin

摘要

Background

Incisional hernia (IH) repair in morbidly obese (MO) patients poses significant challenges due to higher risks of complications and recurrence. Traditional open repairs are linked to increased morbidity, driving interest in minimally invasive techniques. The enhanced view totally extra-peritoneal Rives-Stoppa (eTEP-RS) technique shows promise as a laparoscopic method for IH repair, but data on its efficacy and safety in MO patients are limited. This study aims to evaluate the efficacy, safety, and feasibility of the eTEP-RS approach specifically for IH repair in this high-risk population.

Methods

Analysis of a retrospective cohort of consecutive patients undergoing laparoscopic eTEP-RS for IH repair between 2017 and 2022 which included 135 patients, categorized into two groups based on body mass index (BMI): the MO group (BMI > 35 kg/m2) and the control group (BMI ≤ 35 kg/m2). We compared demographics, comorbidities, hernia characteristics, intra-operative data, post-operative outcomes, and hernia recurrence rates.

Results

Patients in the MO group had significantly more type 2 diabetes mellitus (n = 18, 51% vs n = 25, 25%; p = 0.004), hypertension (n = 35, 73% vs n = 75, 53%; p = 0.017), dyslipidemia (n = 29, 60% vs n = 58, 41%; p = 0.021), ASA score 3 (n = 18, 52% vs n = 23, 23%; p = 0.004), a history of previous umbilical hernia repair (n = 13, 27% vs n = 13, 9.2%; p = 0.002), and bariatric surgery (n = 10, 29% vs n = 13, 13%; p = 0.035). There were no differences in intra-operative characteristics, operative times, or intra-operative complications between groups. During a median follow-up period of 1 year (IQR 40–680 days), there were no differences in hernia recurrence (n = 2, 5.7% vs n = 9, 9%; p = 0.07), time to recurrence, or chronic analgesia usage between groups.

Conclusion

The laparoscopic eTEP-RS approach was safe and effective for IH repair in patients with MO, demonstrating comparable post-operative outcomes and recurrence rates to those with a lower BMI in a selected cohort of patients.