Purpose: Ten to 20% of patients undergoing open gastric bypass surgery will develop incisional hernias and other abdominal wall defects. Plastic surgeons are often called to care for these patients. We evaluate the outcomes of abdominal lipectomy and simultaneous reconstruction of abdominal wall defects resulting from major abdominal surgery.

Methods: 327 patients were treated from 1991 to 2004. 229 presented with primary ventral hernias, 86 with recurrent hernias, and 12 with port site hernias. Components separation was used in 55.9% of the incisional hernias. 11.1% were closed directly and 33% required a bioprosthetic material. A Fleur-de-Lis lipectomy was used in the majority of cases.

Results: Follow-up ranged from 1 to 8 years. 7.3% developed seromas and 0.65% developed hematomas. Minor wound problems occurred in 16.1% and were treated conservatively. Major infection and dehiscence requiring surgical intervention occurred in 8.2%. Only 5.8% of our patients developed recurrent hernias.

Conclusions: Abdominal lipectomy can be combined with abdominal wall reconstruction without a significantly higher risk of complications. Procedures are individualized and based on the reconstructive requirements. Postoperative complications should be managed aggressively with early debridement and closure, while staged reconstruction can be considered when early definitive closure is not feasible or desirable.