Autologous tissue reconstruction of ventral hernias in morbidly obese patients

Hypothesis: Separation of components is a safe and effective technique for abdominal wall reconstruction in morbidly obese patients. Design: Review of a prospectively accumulated database. Setting: University tertiary care medical center. Patients: Thirty morbidly obese patients who underwent ventral hernia repair using the separation of components technique between August 1, 2001, and August 31, 2005. Intervention: Ventral hernia repair using the separation of components technique. Main Outcome Measures: Postoperative complications and hernia recurrence. Results: Thirty morbidly obese patients (mean body mass index [calculated as weight in kilograms divided by height in meters squared], 61; range, 35-93) underwent ventral hernia repair by the separation of components technique (mean width of defect, 12.8 cm; mean length, 17.6 cm). Twenty-five patients (83%) had comorbidities. Twelve (40%) had undergone previous repairs (9 had undergone multiple repairs; mean, 2.4 repairs per patient; range, 2-4 repairs) and 6 (20%) had infected mesh. Sixteen patients (53%) underwent simultaneous panniculectomies and 6 (20%) underwent simultaneous bariatric procedures (Roux-en-Y gastric bypass). Postoperatively, cellulitis developed in 2 patients (7%), which was treated with antibiotics; wound infections occurred in 2 patients (7%), which were managed with local wound care; and a seroma developed in 1 patient (3%), which resolved spontaneously. The lone recurrent hernia (3%) was repaired with mesh. The mean length of follow-up was 44 months. Conclusions: These results show that (1) separation of components is a safe and effective technique for repairing primary and recurrent ventral hernias in morbidly obese patients; (2) performance of a simultaneous panniculectomy or bariatric procedure does not affect the outcome; and (3) comorbidities do not compromise the results.