As I write this column, I am also sitting in anticipation to watch one of my favorite television shows—Biggest Loser. For those of you who may be unfamiliar with the show, it’s a reality show based on a group of overweight contestants who compete to lose the highest percentage of body weight and win a cash grand prize. Every Tuesday night for two hours, I shamelessly watch these people train with professional trainers, impressively drop the weight and simultaneously transform their lives.
As surgical professionals, you very well know that obesity has become a top concern in the healthcare field. As the show portrays, being overweight affects more than one’s appearance—it has an impact in all aspects of an individual’s life. Most importantly, though, obesity severely impacts an individual’s health. In the surgical realm, an overweight patient can present significant procedural challenges when compared to a patient of normal weight.
Especially concerning hernias and hernia repair, studies have shown that obesity is considered a risk factor for the development of primary and incisional hernias. According to a 2006 study in the Archives Of Surgery, higher rates of systemic and wound complications associated with large abdominal incisions in obese patients are “inherent to open herniorrhaphies.” The researchers say that in ventral hernia repair, obese patients face an alarming recurrence rate of up to 50 percent. According to researchers, large abdominal incisions and wide tissue dissection creating large flaps often lead to a high incidence of postoperative morbidity and wound complications.
Recent advances in the use of minimally invasive techniques and new technology is helping to minimize perioperative complications and improve failure rates of hernia repair in obese patients. Multiple studies in recent years have found laparoscopic ventral hernia repair, for example, to be among the best solutions for obese patients, resulting in fewer complications and a lower recurrence rate. Newly-developed prosthetic meshes for tension-free repairs have helped decrease the recurrence rate to less than 20 percent in obese patients.
Still, despite new and advanced technology, patients with a high body mass index (BMI) still face an increased risk of problems associated with hernia repair. A study published in Surgical Endoscopy in 2007 reports that while laparoscopic ventral hernia repair is a safe and effective method for hernia repair in morbidly obese patients, it is still associated with a higher likelihood of recurrence.
While this is just a brief look into the issues surrounding hernia repair in obese patients, the core point remains the same. Obesity is an increasingly important issue among surgical patients today. Not only is their weight impeding on their lives and everyday health, but it is severely hindering the ability to surgically operate on them successfully. Even with advanced techniques and technology, the risks are higher for an obese patient. It’s an issue that will remain at the forefront for surgeons and OR professionals for years to come. Hopefully we can continue to find a solution to make operating on these patients safer, as well help to minimize this condition in the first place.
Outcome of laparoscopic ventral hernia repair in morbidly obese patients with a body mass index exceeding 35 kg/m2. Raftopoulos I, Courcoulas AP. Surg Endosc. 2007 Dec;21(12):2293-7. Epub 2007 May 24.
Laparoscopic Ventral Hernia Repair in Obese Patients: A New Standard of Care Yuri W. Novitsky, MD; William S. Cobb, MD; Kent W. Kercher, MD; Brent D. Matthews, MD; Ronald F. Sing, DO; B. Todd Heniford, MD Arch Surg. 2006;141:57-61.What's your take? E-mail firstname.lastname@example.org