What is the recommended treatment for a fat-containing ventral hernia?

From the Guidelines

The recommended treatment for a fat-containing ventral hernia is surgical repair, which typically involves reducing the herniated fat back into the abdominal cavity and closing the defect in the abdominal wall, often with the placement of a synthetic or biologic mesh to reinforce the abdominal wall and prevent recurrence, as supported by the guidelines from the World Society of Emergency Surgery 1.

Key Considerations

• The surgical approach can be either open or laparoscopic, with the latter offering benefits of smaller incisions and potentially faster recovery.
• Pre-operative weight loss may be recommended for obese patients to reduce surgical risks and improve outcomes.
• Pain management post-surgery usually involves a multimodal approach with medications like acetaminophen and NSAIDs, and possibly short-term opioids for severe pain.
• Most patients can resume light activities within 1-2 weeks but should avoid heavy lifting (over 10 pounds) for 4-6 weeks.

Rationale

The use of mesh in clean surgical fields (CDC wound class I) is associated with a lower recurrence rate, if compared to tissue repair, without an increase in the wound infection rate, as stated in the guidelines 1.

Evidence-Based Recommendations

• For patients having complicated hernia with intestinal incarceration and no signs of intestinal strangulation or concurrent bowel resection (clean surgical field), emergent prosthetic repair with synthetic mesh can be performed, as recommended by the guidelines 1.
• The choice between a cross-linked and a non-cross-linked biological mesh should be evaluated depending on the defect size and degree of contamination, as suggested by the guidelines 1.

Important Considerations

• Early detection of complications such as incarceration and strangulation is crucial to prevent morbidity and mortality, as highlighted in the guidelines 1.
• The guidelines also recommend the use of local anesthesia for emergency inguinal hernia repair in the absence of bowel gangrene, providing effective anesthesia with less postoperative complications 1.

From the Research

Fat-Containing Ventral Hernia Treatment

• The recommended treatment for a fat-containing ventral hernia is not explicitly stated in the provided studies, but several studies discuss the management of ventral hernias in obese patients 2, 3, 4.
• A study published in 2013 suggests that successful treatment of ventral hernias in morbidly obese patients should be individualized based on the patient's symptoms and defined hernia characteristics 3.
• Another study published in 2021 recommends that elective ventral hernia repair (VHR) should not be performed in patients with a body mass index (BMI) ≥ 50 kg/m², current smokers, or patients with glycosylated hemoglobin (HbA1C) ≥ 8.0% 4.
• The same study suggests that patients with BMI = 30-50 kg/m² or HbA1C = 6.5-8.0% require individualized interventions to reduce surgical risk 4.
• A retrospective analysis published in 2019 found that combining ventral hernia repair with panniculectomy (VHR-PAN) in overweight patients may be a safe approach, with comparable increases in quality of life and no significant differences in cost and complication rates compared to VHR alone 5.

Considerations for Treatment

• The management of ventral hernias in obese patients is challenging, and suboptimal outcomes are reported for elective repair in this population 2.
• Preoperative weight loss is ideal but may not be achievable in all patients, and surgeons must carefully weigh the risk of complications from ventral hernia repair with patient symptoms and the ability to achieve adequate weight loss 2.
• The use of mesh reinforcement is recommended for repair of hernias ≥ 2 cm 4.
• Nonoperative management may be considered to have a low risk of short-term morbidity, but the long-term outcomes are unclear 4.