Bariatric Surgery and Hernia Surgery

• There is a significant link between obesity and hernia formation both after abdominal surgery and de novo. There is also evidence that abdominal wall hernias (AWH) can more commonly present with obstruction or strangulation in patients with obesity.
• There is a higher risk for complications and recurrence after hernia repair in patients with obesity.
• In patients with severe obesity and ventral hernia (VH), and both being amenable to laparoscopic repair, combined hernia repair and metabolic/bariatric surgery (MBS) may be safe and associated with good short-term outcomes and low risk of infection. There is a relative lack of evidence, however, about the use of synthetic mesh in this setting.
• In patients with severe obesity and AWH that is not amenable to laparoscopic repair, a staged approach is recommended. Weight loss, whether through surgery or through multidisciplinary medical management, prior to hernia repair is likely to improve hernia repair outcomes. MBS appears to provide far more significant and rapid weight loss than other modalities and would be a good option for selected patients with severe obesity and large, symptomatic AWH.