Rates of Ventral Hernia Repair After Laparoscopic Bariatric Surgery in Sweden

Overview

This registry-based study analyzed ventral hernia repair rates following laparoscopic bariatric surgery in Sweden from 2009 to 2019. It compared incidence between Roux-en-Y Gastric Bypass (LRYGB) and Sleeve Gastrectomy (LSG), finding no clear difference in reoperation rates for incisional hernias between these methods.

Background

Bariatric surgery, primarily performed laparoscopically, is the most effective treatment for morbid obesity. A known complication is incisional hernia, particularly trocar site hernia (TSH), which may be asymptomatic or cause serious complications like bowel incarceration. Obesity increases the risk of hernia development and recurrence due to factors such as increased intra-abdominal pressure and impaired wound healing. The incidence of TSH varies widely in literature, and the timing of hernia occurrence after surgery remains unclear. Sleeve gastrectomy has increased in popularity in Sweden, but its impact on hernia repair rates compared to gastric bypass is not well established.

Data Highlights

The study included all patients undergoing primary laparoscopic gastric bypass or sleeve gastrectomy in Sweden from 2009 to 2019, excluding conversions to open surgery and prior hernia repairs. Data were obtained from the Scandinavian Obesity Surgery Registry and linked to the Swedish National Patient Register. Follow-up extended until hernia repair, death, or end of 2019. A subgroup analysis from 2014 to 2019 was performed due to increased sleeve gastrectomy volume. The registry coverage was high (97% for SOReg and nearly 100% for inpatient NPR data).

Key Findings

• Obesity is a significant risk factor for ventral incisional hernias due to increased intra-abdominal pressure and impaired healing.
• The incidence of trocar site hernias after laparoscopic bariatric surgery varies widely, with imaging detecting more hernias than clinical examination.
• Longer follow-up periods are associated with increased detection of incisional hernias, many of which may be less symptomatic.
• Sleeve gastrectomy often requires enlargement of a trocar site, potentially increasing fascial defects compared to gastric bypass.
• Registry data from Sweden showed no significant difference in ventral hernia repair rates between sleeve gastrectomy and Roux-en-Y gastric bypass.
• The study highlights the need for longer-term follow-up and standardized definitions to better understand hernia incidence post-bariatric surgery.

Clinical Implications

Clinicians should be aware that ventral hernias can develop after laparoscopic bariatric surgery regardless of the surgical method used. Given the potential for serious complications, careful surgical technique and postoperative monitoring are essential. The similar hernia repair rates between LSG and LRYGB suggest that choice of bariatric procedure need not be influenced solely by hernia risk concerns.

Conclusion

This large registry analysis indicates that ventral hernia repair rates following laparoscopic bariatric surgery in Sweden are comparable between sleeve gastrectomy and gastric bypass. Longer follow-up and improved diagnostic criteria are needed to fully characterize the burden of trocar site hernias in this population.

References

1. Swedish Ethical Review Authority 2021 -- Study Approval File no. 2021–05589-02
2. Scandinavian Obesity Surgery Registry (SOReg) -- Registry Description
3. National Patient Register (NPR) -- Data Coverage and Coding