Abdominal wall surgery in bariatric patients

Morbid obesity is one of the main factors related to hernia recurrences after an open repair, while laparoscopic approach has offered excellent results in this type of patients. Concomitant laparoscopic bariatric procedure and ventral hernia repair (VHR) with intraperitoneal mesh has been described as a safe option, but the need to place a mesh intraperitoneally has arisen some concerns. However, the literature does not show good results with the use of transfascial suture neither for primary closures nor with biological meshes. There is still not enough evidence to reach a consensus regarding when is the best time to perform the hernia repair on patients undergoing bariatric surgery, simultaneously or differing the hernia repair. For that reason, it seems that an individualized approach is recommended, informing the patient of the risks and benefits of each option. The type of bariatric surgery, the type and location of the hernia, previous surgery in case of an incisional hernia, symptoms related to the hernia and the surgical approach are factors to be analyzed. It is necessary to consider repairing simultaneously a ventral hernia (VH) in the patient who is going to undergo a bariatric procedure or differing it in order to perform simultaneously a concomitant repair (CR) and the dermolipectomy needed after weight loss. For this reason, only clear symptomatic hernias are recommended to be repair during the bariatric procedure. Finally, it is important to inform properly the patient about possible changes intraoperatively of the bariatric procedure because existing findings, especially due to the presence of adhesions.