Characterization of concurrent bariatric surgery and abdominal wall hernia repair prevalence and outcomes: a multi-centered study of 180,544 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program patients

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BACKGROUND: Abdominal Wall Hernias (AWHs) are common in patients with obesity, yet the optimal management approach and outcomes of concurrent bariatric surgery and hernia repair remain unclear. OBJECTIVES: To compare outcomes of patients who underwent concurrent AWH repair and bariatric surgery with those who had bariatric surgery alone. SETTING: National deidentified database. METHODS: We conducted a retrospective analysis of the 2023 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database, which recently incorporated new Current Procedural Terminology codes capturing detailed hernia characteristics. RESULTS: ; P < .001), and more comorbidities. Most repaired hernias were primary (90.1%), reducible (71.4%), and small-to-medium sized (<3 cm) (94.9%). Concurrent procedures had longer operative times (122.2 ± 64.5 vs. 84.1 ± 48.4 min) and hospital stays (1.5 ± 1.8 vs. 1.2 ± 1.1 days). Reoperation (2.1% vs. .8%), readmission (4.8% vs. 2.9%), serious complications (4.1% vs. 2.5%), and mortality (.3% vs. .07%) were significantly higher with concurrent repair (all P < .001). Multivariable logistic regression analysis identified medium hernia size (3-10 cm) (odds ratio [OR] 1.87), increased age (OR 1.10), history of venous thromboembolism (OR 1.49), and Roux-en-Y gastric bypass (RYGB) (OR 1.72) as independent predictors of serious complications. CONCLUSION: This large-scale national analysis demonstrates that concurrent AWH repair during bariatric surgery is uncommon and might be associated with higher short-term morbidity. These findings should be interpreted as descriptive and hypothesis-generating, highlighting patient- and hernia-specific factors that may inform perioperative risk stratification and shared decision-making, particularly in patients with medium-sized hernias (3-10 cm) or those undergoing RYGB.

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