Background: Obese patients have an increased incidence of ventral hernias; in over 50% of these cases, patients are symptomatic. At the same time, morbid obesity is a disease of epidemic proportions. The combination of symptomatic hernia and obesity is a challenge for the treating surgeon, because the risk of perioperative complications and recurrence increases with increasing BMI. Summary: This review outlines this problem and discusses interdisciplinary approaches to the management of affected patients. In emergency cases, the hernia is treated according to the surgeon’s expertise. In elective cases, an individual decision must be made whether bariatric surgery is indicated before hernia repair or whether both should be performed simultaneously. After bariatric surgery a weight reduction of 25–30% of total body weight in the first year can be achieved and it is often advantageous to perform a bariatric operation prior to hernia repair. Technically, the risk of complications is lower with minimally invasive procedures than with open ones, but laparoscopy is challenging in obese patients, and meshes can only be implanted in intraperitoneal position. This mesh position has to be questioned because of adhesions, recurrence rate, and risk of contamination during re-interventions in patients who are often still relatively young. Key Messages: Obese patients with hernia need to be approached in an interdisciplinary manner, in some patients a weight loss procedure may be advantageous before hernia repair. Recent data show the benefits of robotic hernia surgery in obese patients, as not only haptic advantages result, but especially the mesh can be implanted in a variety of extraperitoneal positions in the abdominal wall with low morbidity.
Visc Med

中文翻译：

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超重和腹疝

背景：肥胖患者腹疝的发生率增加；在这些病例中，超过 50% 的患者有症状。同时，病态肥胖是一种流行病。有症状的疝气和肥胖症的结合对外科医生来说是一个挑战，因为围手术期并发症和复发的风险随着 BMI 的增加而增加。概括：这篇综述概述了这个问题，并讨论了管理受影响患者的跨学科方法。在紧急情况下，疝气会根据外科医生的专业知识进行治疗。在选择性病例中，必须做出个人决定，是在疝修补术之前进行减肥手术还是两者都应该同时进行。减肥手术后的第一年可以实现体重减轻 25-30% 的总体重，并且在疝修补术之前进行减肥手术通常是有利的。从技术上讲，微创手术的并发症风险低于开放手术，但腹腔镜检查对肥胖患者具有挑战性，并且网片只能植入腹膜内位置。由于粘连、复发率、关键信息：肥胖的疝气患者需要以跨学科的方式进行治疗，在某些患者中，在疝气修复之前进行减肥手术可能是有利的。最近的数据显示了机器人疝气手术对肥胖患者的益处，因为不仅可以带来触觉优势，而且特别是网状物可以植入腹壁的各种腹膜外位置，发病率低。
粘性医学