Risk factors for ventral hernia surgery within five years after laparoscopic bariatric surgery: a nationwide Swedish registry-based study 2009–2019
Sandra Ahlqvist, Jakob Walldén, Johan Ottosson, Yücel CengizAbstract
Introduction
Ventral incisional hernia is a known complication following bariatric surgery. A 3% cumulative incidence of ventral hernia surgery five years after bariatric surgery was previously published, showing a higher risk for Roux-en-Y gastric bypass (LRYGB) compared to sleeve gastrectomy (LSG). This risk factor analysis aims to identify predictors of ventral hernia surgery following bariatric surgery in the same cohort, and to determine wether the observed difference between surgical methods persists after adjustment for additional covariates.
Methods
This registry-based cohort includes all patients undergoing primary laparoscopic LRYGB or LSG in Sweden 2009–2019, and links data from the Scandinavian Obesity Surgery Registry (SOReg) to the Swedish Patient Register. Primary endpoint was ventral hernia surgery within five years. Cox proportional hazard models were fitted to examine associations between the outcome and baseline factors, extended with pre-, peri- and postoperative factors.
Results
Higher age and BMI were associated with increased risk of ventral hernia surgery within five years after bariatric surgery. Previous cholecystectomy was associated with higher risk (HR 1.4), as was prior ventral hernia diagnosis (HR 20.6). Longer operative time and concurrent surgery were independent risk factors (HR 1.1 per 30-min increase, and HR 2.0). Non-minor surgery within 30 days increased the risk (HR 3.8). LRYGB demonstrated a persistently higher hazard (HR 1.6) compared to LSG.
Discussion
Patient factors, perioperative factors and previous- and later abdominal surgery can be identified as risk factors for ventral hernia surgery five years after bariatric surgery. The risk for LRYGB remains higher compared to LSG after adjusting for additional factors.