Outcome of laparoscopic ventral hernia repair in morbidly obese patients with a body mass index exceeding 35 kg/m2

Background: Laparoscopic ventral hernia repair (LVHR) for morbidly obese patients with a body mass index (BMI) exceeding 35 kg/m(2) has not been well investigated. Methods: Hernia recurrence was evaluated by surveillance computed tomography. A p value less than 0.05 was considered significant. Results: Between 2003 and 2006, LVHR was attempted for 27 patients with a BMI exceeding 35 kg/m(2). There was one conversion to open surgery (3.7%). The 27 patients included 8 men (29.6%) and 19 women (70.4%) with a mean age of 48 years (range, 33-73 years). The mean BMI was 46.9 kg/m(2) (range, 35-70 kg/m(2)). Nine patients (33%) were superobese (BMI > 50 kg/m(2)), and five patients (22.7%) underwent emergency LVHR because of small bowel obstruction. Concomitant LVHR with laparoscopic gastric bypass (LGB) was performed for 13 patients (48%). Primary, incisional, or recurrent incisional ventral hernia was present in 7 (26%), 15 (55%), and 5 (19%) patients, respectively. A large hernia (>50 cm(2)) was found in 20 patients (74%). The mesh used was porcine submucosal small intestine extracellular matrix for 15 patients (57%), Gore-Tex for 9 patients (35%), and Composix for 2 patients (8%). The mean hernia size was 158 cm(2) (range, 12-806 cm(2)), and the mean mesh size was 374 cm(2) (range, 117-2,400 cm(2)). The mean operative time was 190 min (range, 80-480 min), and the mean hospital length of stay (LOS) was 3.6 days (range, 1-11 days). Minor or major complications occurred in seven patients (25.9%), and five patients (18.5%) experienced recurrence during a mean follow-up period of 14.9 months (range, 3-32 months). Emergency setting, BMI, concomitant LGB, hernia type, hernia size, and mesh type had no statistically significant effect on operative time, LOS, morbidity, or recurrence rates. Conclusions: For morbidly obese patients, LVHR is safe and effective, but it is associated with higher likelihood of recurrence, and patients should be appropriately informed.