Simultaneous Small/Medium Umbilical Hernia Repair with Laparoscopic Sleeve Gastrectomy (LSG): Results of a Retrospective Case-matched Study

Purpose: Periumbilical hernias are a common finding in morbidly obese patients undergoing bariatric surgery; however, the timing of repair is still debated. The aim of this paper is to compare the outcomes of simultaneous versus delayed mesh repair of umbilical hernia in patients undergoing laparoscopic sleeve gastrectomy (LSG). Methods: We retrospectively compared 2 groups of morbidly obese patients with small/medium periumbilical hernia (up to 4 cm) in a casematched study: the first group underwent LSG with simultaneous periumbilical hernia repair; in the second, hernioplasty was performed after weight loss induced by LSG. Patients were matched at a 1:1 ratio according to age, comorbidities, defect size (<2 or ≥2 cm), and obesity grade (<40 or ≥40 kg/m2). Demographic, clinical information, hernia size, data from the surgery, and its complications were retrieved and analyzed. Results: In total, 40 patients were retrieved from our prospectively maintained database and divided into 2 matched groups of 20 subjects each. Baseline characteristics were comparable. After a median time of 19.8±5.6 months, the recurrence rate was not significantly different in the 2 groups. There was no difference in the rate of single complications, but overall morbidity was significantly higher in patients undergoing a 2-step approach. LSG operation time and hospital stay resulted in comparable, but total hospital stay was longer for those readmitted for delayed hernioplasty. Conclusions: In the case of morbidly obese patients with small/ medium periumbilical hernia undergoing LSG, a simultaneous approach should be offered. Our proposed technique did not prolong operative time and showed a lower rate of overall morbidity.