J. J. Yao1,2, T. Pham2, D. Ovando1,2, S. Huerta2 1University Of Texas Southwestern Medical Center,Dallas, TX, USA 2VA North Texas Health Care System,Dallas, TX, USA
Introduction: Outcomes of umbilical hernia repair (UHR) in obese patients remain unclear. We hypothesized that recurrence rates are similar in obese patients and patients with a normal body mass index (BMI) when undergoing similar UHR.
Methods: A retrospective review of UHRs conducted at our institution from 2005 to 2014 identified 199 eligible patients. Demographic, clinical, and laboratory features were compiled. Analysis of rates of recurrence and complications was conducted using Fishers Exact test or X2 and Student’s-T test. One-way ANOVA with a post-hoc Tukey’s multiple comparison test was conducted for analysis of multiple variables. Statistically significant variables identified by Univariate Analysis (UA) were entered into a logistic regression analysis model (MVA). Data is presented as mean±standard deviation. Values were considered significant at p<0.05.
Results: During the study period, 199 patients (mean BMI=32.2 Kg/m2; 97% male; 77% Caucasian; ASA class III/IV=59.2%) underwent UHR performed by one surgeon utilizing a standardized method of primary tissue repair. There were eight patients with recurrences (4.0%); average follow up = 3.9±1.5 years (range 30 days to 9.2 years). Patients who had a recurrence had a similar BMI at the time of surgery (33.5±6.0 Kg/m2 vs. 32.3±4.7 Kg/m2; p=0.29). There were no recurrences among normal BMI patients (0/11); three among overweight patients (3/54); two among class I obese patients (2/73); two among class II obese patients (2/47) and one among morbidly obese patients (1/14); p=0.84. Albumin and ASA were similar in all groups. Recurrence rates among obese and non-obese patients were not significantly different (3.7% vs. 4.6%; p=0.72). UA demonstrated that recurrence was more likely in patients with a history of kidney (12.5% vs. 4.8%; p<0.05) or cardiac (12.5% vs. 5.2%; p <0.05) disease. Patients who presented with a small bowel obstruction (12.5% vs. 1.6%; p<0.001) and those who experienced a postoperative complication (37.5% vs. 12.7%; p<0.05) were also more likely to develop a recurrence. MVA did not identify any independent predictors for recurrence.
There were 18 patients (9.0%) who experienced complications. There was one documented surgical site infection (SSI), but cellulitis in seven additional patients. UA with postoperative complications as the dependent variable showed an association between previous recurrence (12.5% vs. 5.1%; p=0.002) and chronic kidney disease (8.3% vs 4.5%; p=0.03). Three complications were observed in the recurrent cohort: one patient with SSI and two with erythema. BMI was not associated with complications (32.1±5.5 Kg/m2 vs. 32.3±4.7 Kg/m2; p=0.85). MVA did not identify any independent predictors of postoperative complications.
Conclusion: Primary tissue repair is a feasible approach for UHR in obese patients. BMI was not associated with either recurrence or complications among veterans undergoing UHR.