Purpose: Incisional hernias in the abdominal wall are a frequent and serious problem in the post-operative morbidly obese patient, particularly in the post bariatric surgery patient. Diagnosing and addressing abdominal wall hernias is a critical step in the preoperative planning of any abdominal body contouring procedure. Because of the high risk of surgical complications and morbidity in this population, a single-stage procedure simultaneously addressing hernia repair and lipectomy would offer a significant contribution to the management of these patients.

Methods: We performed a retrospective review of all consecutive one-stage hernia repair and body contouring procedures performed by the senior authors from 1999-2005. Patient demographics, operative techniques, and perioperative parameters were reviewed. After accessing the abdominal wall through a direct lipectomy incision, tension free hernia repair was achieved in all patients with external oblique fascial release and underlay tissue separating mesh when necessary. Postoperative complication rates and hernia recurrence rate were used as endpoints to assess the safety and efficacy of the procedure.

Results: 48 patients, 8 males and 40 females, with a mean BMI of 38 are presented. Mean follow-up after surgery was 203 days. 20 patients (42%) had prior history of bariatric surgery. 20 patients (42%) had a primary hernia and 28 patients (58%) presented with recurrent hernia after previous failed repair. Overall complication rate was 24%. Complications included wound infection, hematoma, seroma, and partial flap loss. Hernia recurrence rate was 4%, with both hernias occurring at sites distant from the original repair.

Conclusions: 1. Identification of all abdominal wall defects, and tension free repair with adjunctive fascial release and underlay, tissue separating mesh when necessary results in low hernia recurrence rates. 2. Direct lipectomy incisions provide wide exposure to the abdominal wall and offer excellent access for hernia repair. 3. Herniorrhaphy and body contouring procedures can be safely combined to offer a one-stage procedure with low perioperative morbidity, low hernia recurrence rate, complication rate comparable to that seen with body contouring procedures alone.